Paediatric coma scales

Abstract

Traumatic and non-traumatic coma is a common problem in paediatric practice with high mortality and morbidity. Early recognition of the potential for catastrophic deterioration in a variety of settings is essential and several coma scales have been developed for recording depth of consciousness that are widely used in clinical practice in adults and children. Prediction of outcome is probably less important, as this may be able to be modified by appropriate emergency treatment, and other clinical and neurophysiological criteria allow a greater degree of precision. The scales should be reliable, i.e. with little variation between observers and in test-retest by one observer, since this promotes confidence in the assessments at different time points and by different examiners. This is particularly important when the patient is being assessed by personnel dealing with adults as well as children, discussed on the telephone, handed over at shift change, or transferred between units or hospitals. The British Paediatric Neurology Association has recommended one of the modified child's Glasgow coma scales (CGCS) for use in the UK. This review looks at the recent history of the development of coma scales and the rationale for recommending the CGCS.Traumatic and non-traumatic coma is a common problem in paediatric practice with high mortality and morbidity. 1 Early recognition in a variety of settings is essential and several coma scales have been developed for recording depth of consciousness that are widely used in clinical practice in adults and children. The British Paediatric Neurology Association has recommended one of the modified paediatric Glasgow coma scales (GCS) originally developed by James and Trauner 2 (child's Glasgow coma scale [CGCS]; Tables I, II, and III) for use in the UK. This review looks at the recent history of the development of coma scales and the rationale for recommending the CGCS. Requirements for an ideal coma scale and problems in achieving thisThe criteria for an ideal coma scale are that it should be easily administered, useful in a wide range of ages and clinical conditions, consistent between observers (Table III), and sufficiently discriminating to identify levels of coma requiring specific interventions. Many scales have also been used in attempts to predict outcome, 3-5 although this may be a less realistic goal since the advent of intensive care in the developed world, as sedation and paralysis interfere with the accurate assessment of depth of coma at the time points that are discriminatory, and interventions may alter outcome. None of the clinical scales are sufficiently sensitive or specific enough for it to be justifiable to wake up a patient, sedated and/or paralysed for optimal intensive care, to perform them, especially as additional clinical information 6 and alternative neurophysiological techniques have better predictive power 7 for death and poor neurological outcome respectively. However, GCS at injury or on admission is associated with outcome and was the most important...

Clinical Study of Coma in Children

“…Definitions of study variables were as follows: Coma: A state of unresponsiveness without evidence of awareness of self or environment, a state from which, the patient cannot be aroused by vocal or sensory stimuli. Coma Severity: based on score obtained from modified Glasgow coma scale (5) . Pupils: i) normal -both pupils equal in size, 2-3 mm and reacting equally to light.…”

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

“…47 There are modifications of the adult GCS for children. 27,42,46 Adult patients with a GCS score of ≤ 8 are considered to have "severe" TBI. In children, a GCS score of 5 may be the critical level for "severe" TBI.…”

Unexpected Relationship Between Tympanometry and Mortality in Children With Nontraumatic Coma

“…9 The BCS is a simple score of coma status based on assessment of motor, verbal, and eyeopening ability, similar to the modified Glasgow and Adelaide coma scales but preferred in Africa because of its simplicity, specificity, and better interobserver agreement among health workers in this setting (Table 1). 11,12 After initial assessment at admission, the BCS was assessed every 4 hours by the attending clinicians. Study observations were stopped when the child was found to have a BCS .2.…”