Head injuries in infants and young children: the value of the Paediatric Coma Scale

Abstract

The normal verbal and motor responses embodied in the standard Glasgow Coma Scale (GCS) are not achievable during the first few years of life. The recent literature contains numerous reports of attempts to devise scales of responses quantitating the conscious level in infants and young children, both for research purposes and as clinical guides; some of these scales incorporate items, e.g. brainstem reflexes, that are not included in the GCS. We have reported on a simple paediatric version of the GCS, which uses the standard scale with minor modifications in the verbal component, and sets realistic age-related normal responses. This has been tested prospectively in a series of 60 head-injured infants and children (age range 0-72 months). Of 6 cases recorded as comatose 6 h after injury, 4 have confirmed or suspected residual disabilities. Of 35 cases considered to be fully conscious at 6 h, 31 have made good recoveries and only 1 has suspected residual disabilities. The study suggests that the scale accords with the realities of neurological immaturity, and confirms that it can be used in routine paediatric practice. For comparative therapeutic trials, the conscious level in infants has limited value as an index of brain injury, and should be complemented by other indices, such as brainstem reflexes.

bilinç değişikliği ile acil servise başvuran çocuk hasta: travma mı değil mi

“…Head injuries from trauma is a commonly seen event in children [3][4][5][6] . Post-traumatic brain injury is the most common cause of trauma-related deaths in children 4 .…”

“…Verbal assess of the neurologic status may be challenging especially in pediatric population 5 . Therefore, laboratory and imaging methods are more commonly used to establish differential diagnosis.…”

Extradural Haematoma in Children: Surgical Experiences and Prospective Analysis of 138 Cases

“…Simpson et al 18 pointed out that diagnosis of EDH in a child may not be made until early clinical feature of raised ICP is present. In our series, we evaluated clinical signs as expected.…”

“…Based on clinical findings early diagnosed was established only in small percentage of cases. We believe that CT scan of head should be done routinely in suspected case as early diagnosis of EDH is mandatory for good recovery as radiological changes always occur earlier than clinical changes and should be monitor to predict the clinical progression [18][19][20] .…”

Acute clinical grading in pediatric severe traumatic brain injury and its association with subsequent intracranial pressure, cerebral perfusion pressure, and brain oxygenation

“…For preverbal children, the pediatric coma scale is preferred. 25 In a large series of pediatric severe TBI, Ducrocq et al 9 reported that a threshold GCS score of 5 or less was associated with mortality and poor outcome. In our study, initial GCS demonstrated an association with different measures of CPP and PbtO 2 .…”