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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
|
Eye
Opening |
Score |
|
spontaneously |
4 |
|
to verbal stimuli |
3 |
|
to pain |
2 |
|
never |
1 |
|
Nonverbal
Child |
Verbal
Child's Best Verbal Response
(Glasgow coma scale) |
Score |
|
smiles, oriented to sound, follows objects,
interacts |
oriented and converses |
5 |
|
consolable when crying and interacts
inappropriately |
disoriented and converses |
4 |
|
inconsistently consolable and moans; makes vocal
sounds |
inappropriate words |
3 |
|
inconsolable, irritable and restless; cries |
incomprehensible sounds |
2 |
|
no response |
no response |
1 |
|
Best Motor
Response |
Score |
|
obeys commands |
6 |
|
localizes pain |
5 |
|
flexion withdrawal |
4 |
|
abnormal flexion (decorticate rigidity) |
3 |
|
extension (decerebrate rigidity) |
2 |
|
no response |
1 |
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.
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