Pediatric Glasgow Coma Scale Pdf

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Child’s Glasgow Coma Scale Revised BPNA 2001 Pain should be made by pressing hard on the supra-orbital notch (beneath medial end of eyebrow) with your thumb, except for M4, which is tested by pressing hard on the flat nail. Glasgow Paediatric Coma Score The Paediatric GCS is scored between 3 and 15, 3 being the worst, and 15 the best. It is composed of three parameters: Best Eye Response, Best Verbal Response, Best Motor Response, as given below.

• The Pediatric Glasgow Coma Scale (pGCS) allows providers to obtain, track and communicate the mental status and level of consciousness in preverbal children (≤2 years of age). • Variation of the standard with age appropriate modifications to the motor and verbal components.

• Scored 3-15 (eye, verbal and motor response) like the standard GCS • Should be reported as a sum and include the scores of each of the individual components because of the difference in prognostic value and variations of individual components versus the summed score. Example: Total pCGS 12=E3+V4+M5. () • As accurate for identifying clinically important traumatic brain injury (ciTBI) as GCS in verbal children. Points to keep in mind: • Best to obtain pGCS prior to the administration of analgesics or other interventions that could alter the score. • Somewhat less accurate in identifying those with ANY traumatic brain injury (TBI) on CT compared to the GCS in older children. () • In intubated patients (for whom the verbal score may not be obtained), consider using the Full Outline of UnResponsiveness (FOUR score).

This is a validated, expanded scoring system. () () • Distinction between normal and abnormal flexion may be challenging, especially for the non-specialist. • Several modified pGCS have been created. However, this scale is the only one that has been evaluated in a large, prospective, observational, multicenter, cohort study.

() • Sub-analysis of a large prospective observational multicenter cohort study of children with blunt head trauma that compared the accuracy of the pGCS in preverbal children to the standard GCS score in older children for identifying those with TBIs after blunt head trauma (in the ED) demonstrated statistically similar test performance as that of the standard GCS in older children in identifying ciTBIs. • It also demonstrated somewhat lower accuracy in identifying those with traumatic brain injuries on CT than that of the standard GCS in older children. • With a 95% confidence interval, the area under the ROC curve for association between GCS score and TBI on CT was 0.61 in the younger cohort and 0.71 for the older cohort. The area under the ROC curve for the association between the GCS score and the ciTBI was 0.77 for the younger cohort and 0.81 in the older cohort. • Demonstrated statistically similar test performance as that of the standard GCS in older children in identifying ciTBIs. • Demonstrated somewhat less accuracy in identifying those with traumatic brain injuries on CT than that of the standard GCS in older children.

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• With a 95% confidence interval, the area under the ROC curve for the association between GCS score and TBI on CT was 0.61 in the younger cohort and 0.71 for the older cohort. The area under the ROC curve for the association between the GCS score and the ciTBI was 0.77 for the younger cohort and 0.81 in the older cohort. () • Inter-observer agreement in each cohort for the total score and all individual score components met the criteria for at least moderate inter-observer agreement (kappa 95% lower confidence limit >0.4). • Limitations in the study: • Age threshold of 2 years to define the preverbal pediatric population. • Only 36% of the study population underwent cranial CT imaging. It is possible that some of the children who were not imaged may have had traumatic findings on CT.