Abstract Traumatic and non-traumatic coma is a common problem in paediatric practice with high mortality and morbidity. Early recognition of the potential for catastrophic deterioration in a variety of settings is essential and several coma scales have been developed for recording depth of consciousness that are widely used in clinical practice in adults and children.

The Glasgow Coma Scale (GCS) is used to describe the general level of consciousness in patients with traumatic brain injury (TBI) and to define broad categories of head injury. The GCS is divided into 3 categories, eye opening (E), motor response (M), and verbal response (V). The score is determined. The Blantyre coma scale is a modification of the Glasgow coma scale suitable to use in preverbal. Mgosoft PS To PDF SDK 210 downloads; wolfSSL. Autocad Scale Chart.

Prediction of outcome is probably less important, as this may be able to be modified by appropriate emergency treatment, and other clinical and neurophysiological criteria allow a greater degree of precision. The scales should be reliable, i.e. With little variation between observers and in test-retest by one observer, since this promotes confidence in the assessments at different time points and by different examiners. This is particularly important when the patient is being assessed by personnel dealing with adults as well as children, discussed on the telephone, handed over at shift change, or transferred between units or hospitals. The British Paediatric Neurology Association has recommended one of the modified child's Glasgow coma scales (CGCS) for use in the UK. This review looks at the recent history of the development of coma scales and the rationale for recommending the CGCS.

• 1 Wong CP, Forsyth RJ, Kelly TP, Eyre JA. Incidence, aetiology, and outcome of non-traumatic coma: a population-based study. Arch Dis Child 2001; 84: 193– 99. • • • • • 2 James HE, Trauner DA. The Glasgow Coma Scale.

In: JamesHE, AnasNG, PerkinRM, editors. Brain insults in infants and children: pathophysiology and management. Orlando, Florida: Grune and Stratton Inc. 1985, 179– 82. • 3 Seshia SS, Johnston B, Kasian G. Non-traumatic coma in childhood: clinical variables in prediction of outcome. Dev Med Child Neurol 1983; 25: 493– 501.

• • • • • 4 Nayana PP, Serane TV, Nalini P, Mahadevan S. Long-term outcome in coma. Indian J Pediatr 2005; 72: 293– 95.

• • • 5 Newgard CD, Cudnik M, Warden CR, Hedges JR. The predictive value and appropriate ranges of prehospital physiological parameters for high-risk injured children.

Pediatr Emerg Care 2007; 23: 450– 56. • • • • 6 Van Keulen JG, Polderman KH, Gemke RJ. Reliability of PRISM and PIM scores in paediatric intensive care. Arch Dis Child 2005; 90: 211– 14. • • • • • 7 Zandbergen EG, De Haan RJ, Stoutenbeek CP, Koelman JH, Hijdra A.

Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 1998; 352: 1808– 12. • • • • • 8 Rowley G, Fielding K.

Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. Lancet 1991; 337: 535– 38. • • • • • 9 Newton CR, Kirkham FJ, Johnston B, Marsh K. Inter-observer agreement of the assessment of coma scales and brainstem signs in non-traumatic coma. Dev Med Child Neurol 1995; 37: 807– 13.

• • • • • 10 Newton CR, Chokwe T, Schellenberg JA, et al. Coma scales for children with severe falciparum malaria. Trans R Soc Trop Med Hyg 1997; 91: 161– 65. • • • • • 11 Teasdale G, Jennett B.

Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81– 84. • • • • • 12 Jennett B, Teasdale G. Aspects of coma after severe head injury.

Lancet 1977; 1: 878– 81. • • • • • 13 Langfitt T W. Measuring the outcome from head injuries. J Neurosurg 1978; 48: 673– 78. • • • • • 14 Starmark JE, Stalhammar D, Holmgren E, Rosander B.

A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85). J Neurosurg 1988; 69: 699– 706. • • • • • 15 Teasdale G, Jennett B, Murray L, Murray G. Glasgow coma scale: to sum or not to sum. Lancet 1983; 2: 678.

• • • • • 16 Sacco RL, VanGool R, Mohr JP, Hauser WA. Non-traumatic coma. Glasgow coma score and coma etiology as predictors of 2-week outcome. Arch Neurol 1990; 47: 1181– 84. • • • • • 17 Sugiura K, Muraoka K, Chishiki T, Baba M.

The Edinburgh-2 coma scale: a new scale for assessing impaired consciousness. Neurosurgery 1983; 12: 411– 15.

• • • • • 18 Starmark JE, Holmgren E, Stalhammar D. Current reporting of responsiveness in acute cerebral disorders. A survey of the neurosurgical literature. J Neurosurg 1988; 69: 692– 98. • • • • • 19 Stanczak DE, White JG 3rd, Gouview WD, et al.

Assessment of level of consciousness following severe neurological insult. A comparison of the psychometric qualities of the Glasgow Coma Scale and the Comprehensive Level of Consciousness Scale. J Neurosurg 1984; 60: 955– 60. • • • • • 20 Teasdale G, Murray G, Parker L, Jennett B. Adding up the Glasgow Coma Score. Acta Neurochir Suppl (Wien) 1979; 28: 13– 16. • • • 21 Choi SC, Ward JD, Becker DP.

Chart for outcome prediction in severe head injury. J Neurosurg 1983; 59: 294– 97.

• • • • • 22 Marshall LF, Toole BM, Bowers SA. The National Traumatic Coma Data Bank. Part 2: Patients who talk and deteriorate: implications for treatment.

J Neurosurg 1983; 59: 285– 88. • • • • • 23 Tatman A, Warren A, Williams A, Powell JE, Whitehouse W. Development of a modified paediatric coma scale in intensive care practice. Arch Dis Child 1997; 77: 519– 21. • • • • • 24 Newton CR, Pasvol G, Winstanley PA, Warrell DA. Salary Advice Slip Template South Africa. Cerebral malaria: what is unarousable coma Lancet 1990; 335: 472.

• • • • • 25 Molyneux ME, Taylor TE, Wirima JJ, Borgstein A. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children.

Q J Med 1989; 71: 441– 59. • • • • 26 Starmark JE, Stalhammar D, Holmgren E. The Reaction Level Scale (RLS85). Manual and guidelines. Acta Neurochir (Wien) 1988; 91: 12– 20. • • • • • 27 American College of Surgeons Committee on Trauma.

Advanced life support course for physicians. Chicago, IL: American College of Surgeons, 2003. • 28 Advanced Life Support Group. Recognition of the seriously ill child.

In: Advanced paediatric life support the practical approach. London: BMJ Books, 2001. • • 29 Gill M, Martens K, Lynch EL, Salih A, Green SM. Interrater reliability of 3 simplified neurologic scales applied to adults presenting to the emergency department with altered levels of consciousness. Ann Emerg Med 2007; 49: 403– 07. • • • • 30 Hannan EL, Farrell LS, Meaker PS, Cooper A.

Predicting inpatient mortality for pediatric trauma patients with blunt injuries: a better alternative. J Pediatr Surg 2000; 35: 155– 59.

• • • • • 31 Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF. Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 1987; 67: 648– 56. • • • • • 32 Dhellemmes P, Lejeune JP, Christiaens JL, Combelles G. Traumatic extradural hematomas in infancy and childhood.

Experience with 144 cases. J Neurosurg 1985; 62: 861– 64.

• • • • • 33 Snoek JW, Minderhoud JM, Wilmink JT. Delayed deterioration following mild head injury in children. Brain 1984; 107: 15– 36. Harman Kardon Software Update Avr 1700 Remote. • • • • 34 Menache CC, Du Plessis AJ, Wessel DL, Jonas RA, Newburger J W. Current incidence of acute neurological complications after open-heart operations in children.

Ann Thorac Surg 2002; 73: 1752– 58. • • • • 35 Seshia SS, Seshia MM, Sachdeva RK. Coma in childhood.

Dev Med Child Neurol 1977; 19: 614– 28. • • • • • 36 Bruce DA, Alavi A, Bilaniuk L, Dolinskas C, Obrist W, Uzzell B.

Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema”. J Neurosurg 1981; 54: 170– 78. • • • • • 37 Luerssen TG, Klauber MR, Marshall LF. Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury.

J Neurosurg 1988; 68: 409– 16. • • • • • 38 Reilly PL, Simpson DA, Sprod R, Thomas L.

Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale. Childs Nerv Syst 1988; 4: 30– 33. • • • • 39 Gordon NS, Fois A, Jacobi G, Minns RA, Seshia SS. The management of the comatose child. Neuropediatrics 1983; 14: 3– 5. • • • • • 40 Raimondi AJ, Hirschauer J.

Head injury in the infant and toddler. Coma scoring and outcome scale. Childs Brain 1984; 11: 12– 35. • • • • 41 Morray J P, Tyler DC, Jones TK, Stuntz JT, Lemire RJ. Coma scale for use in brain-injured children.

Crit Care Med 1984; 12: 1018– 20. • • • • • 42 Yager J Y, Johnston B, Seshia SS. Coma scales in pediatric practice. Am J Dis Child 1990; 144: 1088– 91. • • • • 43 Duncan CC, Ment LR, Smith B, Ehrenkranz RA.

A scale for the assessment of neonatal neurologic status. Childs Brain 1981; 8: 299– 306. • • • • 44 Simpson D, Reilly P. Pediatric coma scale.

Lancet 1982; 2: 450. • • • • • 45 Simpson DA, Cockington RA, Hanieh A, Raftos J, Reilly PL. Head injuries in infants and young children: the value of the Paediatric Coma Scale. Review of literature and report on a study. Childs Nerv Sys 1991; 7: 183– 90. • • • • • 46 Berger MS, Pitts LH, Lovely M, Edwards MS, Bartkowski HM.

Outcome from severe head injury in children and adolescents. J Neurosurg 1985; 62: 194– 99. • • • • • 47 Braakman R, Avezaat CJ, Maas AI, Roel M, Schouten HJ. Inter observer agreement in the assessment of the motor response of the Glasgow coma scale. Clin Neurol Neurosurg 1977; 80: 100– 06.

• • • • 48 Born JD, Hans P, Albert A, Bonnal J. Interobserver agreement in assessment of motor response and brain stem reflexes. Neurosurg 1987; 20: 513– 17. • • • • • 49 Newton CR.

Assessment of the grimace component of a coma scale. Arch Dis Child 1998; 79: 532. • • • • • 50 Barret-Goode P. Reliability of the Adelaide Coma Scale.

Paed Nursing 2000; 12: 23– 27. • • 51 Teasdale G, Knill-Jones R, Van Der Sande J. Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry 1978; 41: 603– 10.

• • • • • 52 Murdoch-Eaton D, Darowski M, Livingston J. Cerebral function monitoring in paediatric intensive care: useful features for predicting outcome. Dev Med Child Neurol 2001; 43: 91– 96. • • • • • 53 Mandel R, Martinot A, Delepoulle F, et al. Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study. J Pediatr 2002; 141: 45– 50.

• • • • 54 Mewasingh LD, Christophe C, Fonteyne C, et al. Predictive value of electrophysiology in children with hypoxic coma. Pediatr Neurol 2003; 28: 178– 83. • • • • 55 Rivara F, Tanaguchi D, Parish RA, Stimac GK, Mueller B.

Poor prediction of positive computed tomographic scans by clinical criteria in symptomatic pediatric head trauma. Pediatrics 1987; 80: 579– 84.

• • • • 56 Christophe C, Fonteyne C, Ziereisen F, et al. Value of MR imaging of the brain in children with hypoxic coma. Am J Neuroradiol 2002; 23: 716– 23.

• • • 57 Akhtar JI, Spear RM, Senac MO, Peterson BM, Diaz SM. Detection of traumatic brain injury with magnetic resonance imaging and S-100B protein in children, despite normal computed tomography of the brain. Pediatr Crit Care Med 2003; 4: 322– 26. • • • 58 Berger RP, Pierce MC, Wisniewski SR, Adelson PD, Kochanek PM. Serum S100B concentrations are increased after closed head injury in children: a preliminary study. J Neurotrauma 2002; 19: 1405– 09. • • • • 59 Van Dongen KJ, Braakman R, Gelpke GJ.

The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 1983; 59: 951– 57. • • • • • 60 Talwar D, Torres F. Continuous electrophysiologic monitoring of cerebral function in the pediatric intensive care unit.

Pediatr Neurol 1988; 4: 137– 47. • • • • Related content.