Trauma (Glasgow Coma Scale GCS scores of 14–15) are the group most frequently assessed. These children commonly undergo neuroimaging and account for 40–60% of those with traumatic brain injuries seen on CT.8–11 Less than 10% of CT scans in children with minor head trauma, however, show traumatic brain injuries. The Glasgow Coma Scale was first published in 1974 at the University of Glasgow by neurosurgery professors Graham Teasdale and Bryan Jennett.1 The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor,. 'The is a structured assessment tool that is used before addressing the hands-on ABCs; it allows you to rapidly form a general impression of the pediatric patient's condition without touching him or her. Pediatric assessment triangle B. Glascow Coma Scale C.

Glasgow Coma Scale Teasdale and Jennett published the Glasgow Coma Scale (GCS) in the Lancet in 1974 as an aid in the clinical assessment of post-traumatic unconsciousness. It was devised as a formal scheme to overcome the ambiguities that arose when information about comatose patients was presented and groups of patients compared.

The Paediatric Glasgow Coma Scale (British English) or the Pediatric Glasgow Coma Score (American English) or simply PGCS is the equivalent of the Glasgow Coma Scale (GCS) used to assess the level of consciousness of child patients. As many of the assessments for an adult patient would not be appropriate for infants, the Glasgow Coma Scale was modified slightly to form the PGCS. As with the GCS, the PGCS comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible PGCS (the sum) is 3 (deep coma or death) whilst the highest is 15 (fully awake and aware person). The pediatric GCS is commonly used in emergency medical services.

Coma scale[edit]

Best eye response: (E)[edit]

4. Eyes opening spontaneously

3. Eye opening to speech

2. Eye opening to pain

1. No eye opening or response

Best verbal response: (V)[edit]

5. Smiles, oriented to sounds, follows objects, interacts.

4. Cries but consolable, inappropriate interactions.

3. Inconsistently inconsolable, moaning.

2. Inconsolable, agitated.

1. No verbal response.

Source:^[1]

Best motor responses: (M)[edit]

6. Infant moves spontaneously or purposefully

5. Infant withdraws from touch

4. Infant withdraws from pain

3. Abnormal flexion to pain for an infant (decorticate response)

2. Extension to pain (decerebrate response)

1. No motor response

Any combined score of less than eight represents a significant risk of mortality.

Pediatric Glasgow Coma Scale Pdf In Vector Print

See also[edit]

References[edit]

• Merck Manual. 'Modified Glasgow Coma Scale for Infants and Children'. Retrieved 2008-05-03.CS1 maint: discouraged parameter (link)

1. ^'Archived copy'. Archived from the original on 2016-01-22. Retrieved 2020-04-29.CS1 maint: archived copy as title (link)

Contents

• Glasgow Coma Scale

Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the general level of consciousness in patients with traumatic brain injury (TBI) and to to help gauge the severity of an acute brain injury . The Glasgow Coma Scale (GCS) is divided into 3 categories, eye opening (E), motor response (M), and verbal response (V). The Glasgow Coma Scale score is determined by the sum of the score in each of the 3 categories, with a maximum score of 15 and a minimum score of 3, as follows:

Pediatric Glasgow Coma Scale Pdf In Vector

• Glasgow Coma Scale score = eye opening (E) + motor response (M) + verbal response (V)

Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glascow Coma Scale was designed and should be used to assess the depth and duration coma and impaired consciousness. Glasgow Coma Scale helps to gauge the impact of a wide variety of conditions such as acute brain damage due to traumatic and/or vascular injuries or infections, metabolic disorders (e.g., hepatic or renal failure, hypoglycemia, diabetic ketosis), etc. Education is necessary to the proper application of the Glasgow Coma Scale . The predictive value of the GCS, even when applied early, is limited . Despite these and other limitations , health care practitioners continue to use Glasgow Coma Scale widely.

Glasgow Coma Scale was initially used to assess level of consciousness after head injury, and the Glasgow Coma Scale is now used by first aid, emergency medical services, and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in the intensive care. The Glasgow Coma Scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow’s Institute of Neurological Sciences at the city’s Southern General Hospital .

Eye Opening Response (E)

• Spontaneous–open with blinking at baseline = 4 points
• To verbal stimuli, command, speech = 3 points
• To pain only (not applied to face) = 2 points
• No response = 1 point

Verbal Response (V)

• Oriented conversation = 5 points
• Confused conversation, but able to answer questions = 4 points
• Inappropriate words = 3 points
• Incomprehensible speech or sounds = 2 points
• No response = 1 point

Motor Response (M)

• Obeys verbal commands for movement = 6 points
• Purposeful movement to painful stimuli = 5 points
• Withdraws in response to painful stimuli = 4 points
• Flexion in response to painful stimuli (decorticate posturing) = 3 points
• Extension response in response to painful stimuli (decerebrate posturing) = 2 points
• No response = 1 point

Total Glasgow Coma Scale score = 15

• Total Glasgow Coma Scale score 15 is Normal
• Total Glasgow Coma Scale score 3-14 is Abnormal

Glasgow Coma Scale and Children

The Glasgow Coma Scale has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently, the Pediatric Glasgow Coma Scale or PGCS, a separate yet closely related scale, was developed for assessing young children. The Pediatric Glasgow Coma Scale still uses the three tests — eye, verbal, and motor responses — and the three values are considered separately as well as together.

Pediatric brain injuries are classified by severity using the same scoring levels as adults, i.e. 8 or lower reflecting the most severe, 9-12 being a moderate injury and 13-15 indicating a mild traumatic brain injury (TBI). As in adults, moderate and severe injuries often result in significant long-term impairments.

Table 1. Pediatric Glasgow Coma Scale for Children

Glasgow coma scale interpretation

A patient’s Glasgow Coma Score (GCS) should be documented on a coma scale chart. This allows for improvement or deterioration in a patient’s condition to be quickly and clearly communicated. Individual elements, as well as the sum of the Glasgow Coma Scale score, are important. The individual elements of a patient’s GCS can be documented numerically (e.g. E2V4M6) as well as added together to give a total Coma Score (e.g E2V4M6 = 12). For example, the Glasgow Coma Scale score is expressed in the form “GCS 12 = E2 V4 M6 at 07:35”. Generally, when a patient is in a decline of their Glasgow Coma Scale score, the nurse or medical staff should assess the cranial nerves and determine which of the twelve have been affected.

Patients who are intubated are unable to speak, and their verbal score cannot be assessed. They are evaluated only based on eye opening and motor scores, and the suffix T is added to their score to indicate intubation. In intubated patients, the maximum Glasgow Coma Scale score is 10T and the minimum score is 2T. Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached e.g. “E1C” where “C” = closed, or “V1T” where T = tube. A composite might be “GCS 5TC”. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for “abnormal flexion”. Often the 1 is left out, so the scale reads Ec or Vt.

The Glasgow Coma Scale is often used to help define the severity of traumatic brain injury (TBI). Mild head injuries are generally defined as those associated with a GCS score of 13-15, and moderate head injuries are those associated with a GCS score of 9-12. A GCS score of 8 or less defines a severe head injury. These definitions are not rigid and should be considered as a general guide to the level of injury.

Every brain injury is different, but generally, brain injury is classified as:

• Severe Head Injury: Glasgow Coma Score 8 or less
• Moderate Head Injury: Glasgow Coma Score 9-12
• Mild Head Injury: Glasgow Coma Score 13-15

Mild brain injuries can result in temporary or permanent neurological symptoms and neuroimaging tests such as CT scan or MRI may or may not show evidence of any damage.

Pediatric Glasgow Coma Scale Pdf

Moderate and severe brain injuries often result in long-term impairments in cognition (thinking skills), physical skills, and/or emotional/behavioral functioning.

Brain injury is classified as:

• Glasgow Coma Scale 8-15 and somnolence: Sleepy, easy to wake
• Glasgow Coma Scale 8-15 and stupor: Hypnoid, hard to wake
• Glasgow Coma Scale 13-15: Mild Head Injury
• Glasgow Coma Scale 9–12: Moderate Head Injury
• Glasgow Coma Scale 3–8: Coma = No eye opening, no ability to follow commands and no word verbalizations
• Glasgow Coma Scale ≤ 8: Severe Head Injury
• Glasgow Coma Scale 7-8: Light coma; Coma Grade I
• Glasgow Coma Scale 5-6: Light coma; Coma Grade II
• Glasgow Coma Scale 4: Deep coma; Coma Grade III
• Glasgow Coma Scale 3: Deep coma; Coma Grade IV

Limitations of the Glasgow Coma Scale

Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patient’s level of consciousness. These factors could lead to an inaccurate score on the Glasgow Coma Scale.