This work was supported by a grant from the Health Resources and Services Administration/Maternal and Child Health Bureau (HRSA/MCHB), Division of Research, Education, and Training, and the Emergency Medical Services of Children (EMSC) Program (R40MC02461). This project was also supported in part by HRSA, MCHB, and the EMSC Network Development Demonstration Program under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685. 40th anniversary of the Glasgow Coma Scale. Glasgow Coma Scale Assessment Aid available as PDF download in multiple languages Click the button below: Download. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Methods This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. ![]() Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children. Results We enrolled 42,041 patients, of whom 10,499 (25.0%) were. The Glasgow Coma Scale (GCS) score is one of the most recognized and widely used tools for assessment of level of consciousness and severity of mental status alteration in patients with traumatic brain injuries (TBIs) and a variety of other neurologic conditions. The GCS score is calculated by adding the scores of the following three components: eye response (range = 1–4), verbal response (range = 1–5), and motor response (range = 1–6). The GCS score is used to categorize TBI severity as mild, moderate, or severe; is a component of outcome prediction models; and is used to guide therapy. Due to the need for verbal interaction, clinicians cannot use the standard GCS score to appropriately assess preverbal children. Therefore, the pediatric GCS score is a modified GCS score for use in preverbal children. The pediatric GCS uses age‐appropriate modifications to account for developmental differences in verbal, motor, and cognitive abilities (Table ). Score Standard GCS Pediatric GCS Eye opening 4 Spontaneous Spontaneous 3 To voice To voice 2 To pain To pain 1 None None Verbal response 5 Oriented Coos/babbles 4 Confused Irritable/cries 3 Inappropriate words Cries to pain 2 Incomprehensible sounds Moans 1 None None Motor response 6 Follows commands Spontaneous movement 5 Localizes pain Withdraws to touch 4 Withdraws to pain Withdraws to pain 3 Abnormal flexure posturing Abnormal flexure posturing 2 Abnormal extension posturing Abnormal extension posturing 1 None None. • GCS = Glasgow Coma Scale. There has been very limited prospective study, however, of the accuracy of the pediatric GCS in identifying young children with TBIs, particularly in the emergency department (ED) setting. Our prior research at a single ED suggests that the pediatric GCS score in children 2 years and younger compares favorably with the standard GCS when used for the evaluation of blunt head trauma in older children. These data, however, require further validation in a larger study. We previously conducted a large prospective multicenter study to develop and validate prediction rules for identifying children with clinically important TBIs (ciTBIs) after blunt head trauma. The standard GCS score for older children and the pediatric GCS score for children younger than 2 years were prospectively collected at ED presentation. In the current subanalysis of the parent study, we sought to compare the performance of the pediatric and standard GCS scores for identifying children with TBIs on computed tomography (CT) and ciTBIs. The secondary objective was to compare the performance of the individual components of the standard and pediatric GCS scores. We hypothesized that the pediatric GCS score in preverbal children would perform as well as the standard GCS score in verbal children for identifying those with TBIs. Study Protocol The ED clinician completed a history and physical examination on each patient and recorded the data onto a case report form before CT scan results or clinical outcomes were known. Two faculty or fellow physicians independently evaluated a convenience sample of 1,443 patients with all three GCS components documented by both evaluators to determine the interobserver agreement for GCS. The second evaluation was completed within 1 hour of the first evaluation.
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September 2018
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