Overview :

One of the components of the Glasgow coma scale is the best verbal response, which cannot be assessed in nonverbal small children. A modification of the original Glasgow coma scale was created for children too young to talk.

Parameters:

(1) eyes opening

(2) best verbal or nonverbal response (depending on development status)

(3) best motor response

Additional markers associated with prognosis:

(1) oculovestibular reflex (all children with absent reflexes died; 50% of children with impaired reflex died; 25% with normal reflexes died)

(2) abnormal pupillary response (77% with bilateral fixed and dilated pupils died)

(3) intracranial pressure (pressures > 40 torr with CCS scores of 3, 4 or 5 was inevitably fatal)

children's coma scale =

= (score for eye opening) + (score for best nonverbal or verbal response) + (score for best motor response)

Interpretation:

• minimum score is 3, which has the worst prognosis

• maximum score is 15, which has the best prognosis

• Scores of 7 or above have a good chance for recovery.

• Scores of 3-5 are potentially fatal, especially if accompanied by fixed pupils or absent oculovestibular responses or elevated intracranial pressure.

• Normal children under 5 years may have lower scores than adults because of reduced best verbal and motor responses.

Hahn YS, Chyung C, et al. Head injuries in children under 36 months of age. Child's Nerv Syst. 1988; 4: 34-40.

Jaffe D, Wesson D. Emergency management of blunt trauma in children. N Engl J Med. 1991; 324:1477-1482.

Simpson D, Reilly P. Pediatric Coma Scale (Letter to the Editor). Lancet. 1982; 2: 450.