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Role of Glasgow Coma Scale in pediatric nontraumatic coma
P C Nayana Prabha1, P Nalini, V Tiroumourougane Serane
1Department of Pediatrics, Jawaharalal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry 605 006, India. drnayanap@yahoo.com
Insights
The Modified Glasgow Coma Scale (MGCS) and its components, particularly brainstem reflexes, ocular, and motor responses, are linked to survival in children with acute coma. These factors are crucial for assessing prognosis in pediatric coma patients.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neuroscience
Background:
- Acute coma in children presents a significant clinical challenge.
- Accurate prognostication is essential for guiding treatment and resource allocation.
- The Modified Glasgow Coma Scale (MGCS) is a common tool, but its predictive value for survival in pediatric non-traumatic coma requires further evaluation.
Purpose of the Study:
- To evaluate the relationship between the Modified Glasgow Coma Scale (MGCS) and its individual components with survival in children experiencing acute coma.
- To determine the predictive value of MGCS components for short-term outcomes in this pediatric population.
Main Methods:
- A prospective observational study was conducted at a tertiary care referral hospital.
- 270 children aged 2 months to 12 years with acute non-traumatic coma were enrolled.
- The MGCS and brainstem reflexes were assessed every 6 hours for 72 hours, with the lowest scores and worst reflexes analyzed for their association with survival.
Main Results:
- All assessed components, including the total MGCS score, ocular response, motor response, verbal response, and brainstem reflexes, showed a significant association with adverse outcomes (p < 0.001).
- Brainstem reflexes demonstrated the strongest correlation with adverse outcomes (Spearman's rho = 0.843).
- Multivariate regression analysis identified ocular response and motor response as independent predictors of short-term survival.
Conclusions:
- The study highlights the strong association between MGCS components and survival in children with acute coma.
- Brainstem reflexes, ocular response, and motor response are key indicators for prognostication.
- Further research should focus on developing and validating a prognostic score that integrates these critical elements for comatose pediatric patients.
Objective:
To assess the relationship between Modified Glasgow Coma Scale (MGCS), its components and survival in children with acute coma.
Design:
Prospective observational study.
Setting:
Tertiary care referral hospital.
Patients:
Consecutive children (n = 270) with acute nontraumatic coma between 2 months to 12 years.
Methodology:
MGCS and brainstem reflexes were assessed at 6 hourly intervals for 72 hours from the time of admission. The lowest score of the MGCS and worst brain stem reflexes were used for the analysis.
Main Outcome Measure:
Survival.
Results:
Total score (Spearman rank correlation coefficient IRI = O.577, ocular response (IRI = O.641), motor response (IRI = O.729), verbal response (lRI = 0.608), brain stem response (lRI = O.843) were all found to be associated with adverse outcome. Multivariate regression analysis revealed that ocular response and motor response were individually predictive of short-term outcome.
Conclusion:
A score incorporating the brain stem reflexes, ocular response and motor response in the assessment and prognostication of comatose patients needs to be evaluated.