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Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale
P L Reilly1, D A Simpson, R Sprod
1Adelaide Children's Hospital, Australia.
Insights
A new pediatric coma scale was developed for children under 5, addressing limitations of the adult Glasgow Coma Scale. Assessments using this age-specific scale showed reasonable observer consistency after training.
Area of Science:
- Neurology
- Pediatrics
- Clinical Assessment
Background:
- The standard Glasgow Coma Scale (GCS) is a widely accepted measure for assessing impaired consciousness in adults.
- The standard GCS is not applicable to infants and children under 5 years of age, creating a gap in pediatric neurological assessment.
- Accurate assessment of consciousness in young children is crucial for clinical practice and research.
Purpose of the Study:
- To devise and evaluate a pediatric coma scale suitable for infants and children under 5 years.
- To ensure the scale accounts for age-specific normal verbal and motor responses.
- To assess the reliability and consistency of observer evaluations using the new scale.
Main Methods:
- Development of an age-related pediatric coma scale.
- Routine clinical use of the scale in a pediatric teaching hospital over a 10-year period.
- Assessment of inter-observer reliability using video recordings of pediatric patients with varying consciousness levels.
Main Results:
- The pediatric coma scale has been used satisfactorily in a clinical setting for a decade.
- The scale is less sensitive to subtle changes in consciousness compared to the adult GCS.
- Observer assessments demonstrated reasonable consistency after formal instruction in scale administration.
Conclusions:
- The developed pediatric coma scale provides a viable alternative for assessing consciousness in young children.
- Age-appropriateness is key for effective neurological assessment in pediatric populations.
- Formal training enhances the reliability of the pediatric coma scale in clinical practice.
Abstract:
The Glasgow Coma Scale is widely accepted as a measure of impaired consciousness both in clinical practice and in research. In its standard form, the scale is inapplicable to infants and children below the age of 5 years. We have devised a paediatric coma scale, which recognises that the expected normal verbal and motor responses must be related to the patient's age. This scale has been routinely used in a paediatric teaching hospital over a 10-year period and has appeared to be satisfactory, although it is less sensitive to changes in the conscious level than the adult scale. We have assessed the consistency of observer evaluation, using video tapes of infants and children exhibiting varying levels of consciousness: when conducted after formal instruction, assessments were reasonably consistent.