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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.

American Journal of Diseases of Children (1960)
|October 1, 1990
PubMed
Summary
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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.

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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.