Pediatric Glasgow Coma Scale Calculator

How does this Pediatric Glasgow Coma Scale calculator work?

This is a health tool that evaluates the mental status of child patients in the emergency room based on an adaptation of the Glasgow Coma Scale (with more infant specific reactions and stimuli analysis).

Each of the three types of response analyzed is described below:

■ Best eye response [E] – focuses on eye movement and recognition of external stimuli:

- Eyes opening spontaneously (4 points);

- Eye opening to speech (3 points);

- Eye opening to pain (2 points);

- No eye opening or response (1 point).

■ Best verbal response [V] – analyses the ability of the infant/ child to interact with people and surrounding objects:

- Smiles, oriented to sounds, follows objects, interacts (5 points);

- Cries but consolable, inappropriate interactions (4 points);

- Inconsistently inconsolable, moaning (3 points);

- Inconsolable, agitated (2 points);

- No verbal response (1 point);

■ Best motor responses [M] – evaluates the degree of mobility of the pediatric patient and whether they are able to exert the normal reflexes of withdrawal from the painful stimuli:

- Infant moves spontaneously or purposefully (6 points);

- Infant withdraws from touch (5 points);

- Infant withdraws from pain (4 points);

- Abnormal flexion to pain for an infant (decorticate response) (3 points);

- Extension to pain (decerebrate response) (2 points);

- No motor response (1 point).

After the results in each of the three tests are registered, the Pediatric Glasgow Coma Scale calculator sums them and provides an indication of the patient status.

Once the modified version of the Glasgow Coma Scale has been published, given the reluctance in applying it, several studies concerning its performance have followed, with areas such as blunt head trauma or other types of infant trauma.

The medical world was concerned whether administering the scale based test to a patient not able to speak or exhibit unaltered neurological response, would be a reliable mean to base subsequent clinical decision making upon.

There are other tests and evaluation criteria that have been adapted for pediatric use, such as PELD, the pediatric version of the End Model for Liver Disease (MELD).

The main findings have been that the pediatric version is comparable in efficiency with the standard adult version in infants of 2 years and below. Score results provide a helpful tool in aiding clinicians choose for acute intervention. This version is preferred to other standard consciousness assessments as AVPU who are not as specific as to account for pediatric patient age.

PGCS scores interpretation

Results range from 3, associated with coma or death to 15, indicating the child is fully aware and awake. Scores of 12 indicate severe head injury, scores below 8 require intubation and ventilation while scores below 6 should also be monitored intracranial pressure.

Clinicians often break down the score per its components to communicate more information so often the PGCS result will be something like GCS of 9 followed by E3V4M2.

This describes a patient in critical condition, nearing the mark that requires intubation and artificial ventilation, with the best eye response to speech stimulation, an infant or child who cries but consolable and might portray inappropriate interactions and exhibiting extension to pain (decerebrate response).

References

1) Wilberger JE, Dupre DA. (2013) ‘Traumatic Brain Injury’ in Merck Manual Professional Version

2) Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. (2005) Performance of the pediatric glasgow coma scale in children with blunt head trauma. Acad Emerg Med; 12(9):814-9.

3) Davis RJ et al: Head and spinal cord injury. In Textbook of Pediatric Intensive Care, edited by MC Rogers. Baltimore, Williams & Wilkins, 1987; James H, Anas N, Perkin RM: Brain Insults in Infants and Children. New York, Grune & Stratton, 1985; and Morray JP et al: Coma scale for use in brain-injured children. Critical Care Medicine 12:1018