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 Release 24.0, April 2009
 
Chapter : ch17. Neurology Section : Coma Scales
  COHMC Coma Scale for Brain-Injured Children

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Copyright (c) 2006-2007, Institute for Algorithmic Medicine, Houston, TX, USA. All rights reserved.

Overview :

The COHMC (Children's Orthopedic Hospital and Medical Center, Seattle, Washington) coma scale can be used to assess children with a variety of central nervous system injuries. Since verbalization is not assessed, it can be used with preverbal or previously intubated children.

 

Function

Findings

Score

cortical function subtotal

purposeful, spontaneous movements

6

 

purposeful, voice-evoked movements

5

 

painful stimulus localized

4

 

nonpurposeful movements, global withdrawal

3

 

decorticate posturing

2

 

decerebrate posturing

1

 

flaccid

0

brainstem function subtotal

intact (pupillary light reflex, corneal reflex and oculovestibular or oculocephalic reflexes present and normal)

3

 

depressed (pupillary light reflex, corneal reflex and oculovestibular or oculocephalic reflexes delayed or diminished, or some reflexes present while others absent)

2

 

absent but breathing spontaneously

1

 

absent and apneic (with normal PaCO2)

0

 

COHMC coma scale =

= (cortical function subtotal) + (brainstem function subtotal)

 

Interpretation:

• minimum score: 0 (poor)

• maximum score: 9 (good)

• mortality very high for children with scores < 3

• no children admitted with flaccidity survived

 

  References:

Morray JP, Tyler DC, et al. Coma scale for use in brain-injured children. Crit Care Med. 1984; 12: 1018-1020.

 

 

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