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Coma scales in pediatric practice
J Y Yager1, B Johnston, S S Seshia
1Section of Pediatric Neurosciences, University of Manitoba, Winnipeg, Canada.
Insights
This study evaluated six coma scales in pediatric patients. The Simpson and Reilly Scale and Jacobi Scale demonstrated superior interobserver agreement, making them more suitable for clinical use.
Area of Science:
- Pediatric Neurology
- Clinical Assessment Tools
Background:
- Accurate assessment of pediatric coma is crucial for patient management and research.
- Existing coma scales exhibit varying degrees of interobserver reliability.
Purpose of the Study:
- To prospectively assess interobserver variability of six coma scales in comatose children.
- To identify coma scales with optimal reliability for pediatric use.
Main Methods:
- Prospective evaluation of 15 comatose children by two physicians in a double-blind manner.
- Assessment of Glasgow Coma Scale, Simpson and Reilly Scale, Children's Coma Score, Children's Orthopedic Hospital and Medical Center Scale, Jacobi Scale, and 0 to IV Scale.
- Interobserver variability measured using disagreement rate and kappa statistic.
Main Results:
- Disagreement rates ranged from 0.03 to 0.20.
- Higher disagreement (>0.10) observed for verbal responses in Children's Coma Score and Glasgow Coma Scale, and for all items in Children's Orthopedic Hospital and Medical Center Scale.
- Lower disagreement (≤0.10) for 0 to IV Scale and all items in Simpson and Reilly and Jacobi scales.
Conclusions:
- The Simpson and Reilly Scale and Jacobi Scale demonstrated high interobserver agreement in pediatric coma assessment.
- These scales are recommended for reliable data interpretation in clinical practice and research involving comatose children.
Abstract:
Interobserver variability for six coma scales was assessed prospectively on a sample of 15 comatose children, by two physicians, in a double-blind fashion. The six scales were the Glasgow Coma Scale, the Simpson and Reilly Scale, the Children's Coma Score, the Children's Orthopedic Hospital and Medical Center Scale, the Jacobi Scale, and the 0 to IV Scale. Interobserver variability was measured by using disagreement rate and the kappa statistic. The results from both methods were generally concordant. The disagreement rate for the various items in the different scales ranged from a high of 0.20 to a low of 0.03. The disagreement rate was greater than 0.10 for verbal responses in the Children's Coma Score and Glasgow Coma Scale and for both items in the Children's Orthopedic Hospital and Medical Center Scale. The disagreement rate was 0.10 or less for the 0 to IV Scale and for all items in the Simpson and Reilly and Jacobi scales. The relatively high interobserver agreement for these scales makes them more suitable for the pediatric setting than the other three scales, since good agreement is essential for interpreting data reliably, both in clinical practice and for research.