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Overview :
The Pittsburgh Brain Stem Score (PBSS) can be used to assess
brain stem reflexes in a comatose patient.
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Brain Stem Reflex
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Finding
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Points
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lash reflex
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present either side
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2
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absent both sides
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1
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corneal reflex
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present either side
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2
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absent both sides
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1
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doll's eye and/or ice water calorics
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present either side
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2
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absent both sides
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1
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right pupil reaction to light
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present
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2
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absent
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1
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left pupil reaction to light
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present
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2
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absent
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1
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gag and/or cough reflex
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present
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2
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absent
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1
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(see Table 3 Schuster and Dick, page 33; Table 3 BRCT II,
page 530)
Pittsburgh
brain stem score =
= SUM(points for reflexes)
Interpretation:
• minimum
score: 6
• maximum
score: 12
• The higher
the score, the better.
• The PBSS may
be added to the Glasgow Coma score to give a combined Glasgow-Pittsburgh Coma
Score. With the above configuration to the PBSS, the combined score would have
a range of 9 - 27.
Variations:
• In the Brain
Resuscitation Clinical Trial, the lash and corneal reflex appear to represent a
single scored parameter.
• In Edgren et
al a modified Pittsburgh
score (undefined) is reported to have a best score of 20 and a worst score of
4.
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