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Glasgow Coma Scale and Brain Injury In Children

The Glasgow Coma Scale is one of the most widely used scales to determine the initial severity of injury following head trauma. It's predictive value for determining outcome is still a subject of much debate.

The score measures the following areas of functioning: Eye opening, Verbal Response, Motor Response and grades each area of response on a scale of 1 to 4 points.  The scores in these three areas are added up and totaled to determine the initial severity of injury.  The end score can be from 3 to 15. (note you can be just about dead and still get 3 points on this scale).

[I am reproducing the entire scoring system for the glasgow coma scale at the end of this post]

Now to today's brain injury article of interest: The May issue of the journal Pediatric Neurology reports a new study concerning the predictive value of the glasgow coma scale in determining outcome for children with traumatic brain injury. 

The authors conclude that that subarachnoid hemorrhage with brain swelling and edema, subdural and intracerebral hemorrhage are most often associated with severe injury and poor outcome.   Scores of 5 and under have the worst predictive outcome in children following brain trauma. Pediatr Neurol. 2006 May; 34(5): 379-87.

More information on the Glasgow Coma Scale and Scoring:

The glascow coma scale is used to measure the initial severity of a brain injury and the extent of brain damage.  It was developed in Glasgow, Scotland and has gained wide spread acceptance in clasifying the initial severity of damage and to plan future treatment and neurological interventions.

Eye Opening Response:
Spontaneous-open with blinking at baseline...........4 points
To verbal stimuli, command, speech...................3 points
To pain only (not applied to face)......................2 points
No response................................................1 point

Verbal Response:
Oriented.........................................................4 points
Confused conversations, but able to answer questions....3 points
Inappropriate words............................................3 points
Incomprehensible speech......................................2 points
No response......................................................1 point

Motor Response:
Obeys commands for movement.............................6 points
Purposeful movement to painful stimulus...................5 points
Withdraws in response to pain...............................4 points
Flexion in response to pain (decorticate posturing).......3 points
Extension in response to pain (decerebrate posturing)....2 points
No response......................................................1 point

Categorizations:
Coma: No eye opening, no ability to follow commands
and no word verbalizations....................................3-8 points

Head injury Classifications:
Severe Head Injury...................................Score of 8 or less
Moderate Head Injury................................Score of 9 to 12
Mild Head Injury.......................................Score of 13 to 15

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