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Coma scale for use in brain-injured children
Insights
A new pediatric coma scale, excluding verbalization, shows moderate success in predicting outcomes for children with central nervous system injuries. A score below 3 or flaccidity indicated no survival, regardless of treatment.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Clinical Assessment Tools
Background:
- Assessing neurological status in critically ill children is crucial for predicting outcomes.
- Existing coma scales, like the Glasgow Coma Scale, may be limited in preverbal or intubated pediatric patients.
- A need exists for a coma scale adaptable to diverse pediatric central nervous system injuries.
Purpose of the Study:
- To evaluate the association between a novel pediatric coma scale score on admission and the eventual outcome in children with central nervous system injuries.
- To determine the scale's efficacy in predicting outcomes across different pediatric neurological conditions.
Main Methods:
- A coma scale assessing cortical and brainstem function (max score 9) was utilized.
- The scale was applied to 91 children treated for intracranial hypertension.
- Outcome prediction was compared across various etiologies including hypoxic encephalopathy, head trauma, Reye's syndrome, meningitis, and encephalitis.
Main Results:
- A moderately good association was found between admission coma score and eventual outcome.
- The scale demonstrated better predictive accuracy for hypoxic encephalopathy and head trauma compared to Reye's syndrome, meningitis, or encephalitis.
- No child scoring below 3 survived, with most exhibiting flaccidity and absent brainstem reflexes.
- Complete flaccidity on admission was universally associated with non-survival.
Conclusions:
- The developed pediatric coma scale shows potential as a prognostic tool in pediatric neurocritical care.
- The scale's utility is more pronounced in traumatic and hypoxic brain injuries than in infectious or inflammatory conditions.
- Admission neurological status, particularly the absence of motor function and brainstem reflexes, is a critical determinant of survival in pediatric CNS injury.
Abstract:
The association between admission coma score and eventual outcome was assessed using a coma scale developed for children with a variety of central nervous system injuries. As opposed to the Glasgow coma scale, this scale does not demand assessment of verbalization, and thus can be applied to the preverbal or previously intubated child. Cortical function is graded from 6 (purposeful, spontaneous movements) to 0 (flaccid), and brainstem function is graded from 3 (intact) to 0 (absent and apneic). Maximum total score is 9. In 91 children treated for intracranial hypertension, the association was moderately good. The scale was better in predicting the outcome of patients with hypoxic encephalopathy and head trauma than that of patients with Reye's syndrome, meningitis, or encephalitis. No child with a score of less than 3 survived in spite of intensive therapy. Most of these children were flaccid with depressed or absent brainstem reflexes. No child with flaccidity on admission survived.