Pediatric Glasgow Coma Scale (pGCS)

Helps emergency room evaluation of infant and child patients with trauma.

In the text below the calculator there is more information about the score and its interpretation.


The pediatric Glasgow coma scale is the modified version of the GCS for use in infant and child patients with head trauma. It focuses on three domains of function: eye, verbal and motor response.

A finding of subsequent validation studies was that the pediatric version is comparable in efficiency with the standard adult version in children of 2 years and below.


The scores in this pediatric scale vary from 3 to 15, where 3 is associated with coma or exitus and 15 means the infant is fully awake and aware.

The following table summarizes the pGCS scores and their interpretation:

pGCS score Head injury Recommendation
≥13 Minor Further monitoring
9 - 12 Moderate Further monitoring
≤8 Severe May require intubation and mechanical ventilation. Scores below 6 need to have intracranial pressure monitored.

1

Best eye response

2

Best verbal response

3

Best motor responses

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About pGCS

This is the modified version of the Glasgow Coma Scale (adapted for use in pediatric patients younger than 2 years old). The scale evaluates the mental status of patients presenting to ER with head trauma.

Because of its use in infant patients, the scale looks for specific reactions to stimuli, for example the verbal response focuses on cry and orientation, thus bypasses the verbalization requirement that the adult scale has.

The three domains of nervous function that are analysed, can be found in the table below:

pGCS response Points Type of response
Best eye response [E] - focuses on eye movement and recognition of external stimuli 4 Eyes opening spontaneously
3 Eye opening to speech
2 Eye opening to pain
1 No eye opening or response
Best verbal response [V] - analyses the infant’s interaction with people and surrounding objects 5 Smiles, oriented to sounds, follows objects, interacts
4 Cries but consolable, inappropriate interactions
3 Inconsistently inconsolable, moaning
2 Inconsolable, agitated
1 No verbal response
Best motor responses [M] - evaluates the degree of mobility and reflex responses to painful stimuli 6 Infant moves spontaneously or purposefully
5 Infant withdraws from touch
4 Infant withdraws from pain
3 Abnormal flexion to pain for an infant (decorticate response)
2 Extension to pain (decerebrate response)
1 No motor response

The result from the pGCS helps clinicians choose the appropriate management of the acute condition (head injury).

There are other examples of adult scales adapted for use in infant and child patients, such as the Pediatric Early Warning Score (PEWS) or the PELD, the pediatric version of the End Model for Liver Disease (MELD).

 

Result interpretation

The pGCS is scored in a similar manner to the adult version, with results ranging from 3 to 15, where 3 indicates coma or exitus and 15 indicates a patient that is fully aware and awake.

Any score below 12 is indicative of moderate to severe head injury. Patients who score below 8 are likely to require intubation and those scoring below 6 should also have the intracranial pressure monitored.

When the score is reported, it is sometimes broken down per components to communicate more information. For example, a score of 11 could be followed by E4V4M3.

This describes a patient that may suffer from moderate to severe head trauma, who is not likely to require intubation, with spontaneous eye opening, with cry that is consolable and with abnormal flexion to pain for an infant (decorticate response).

 

Strengths and limitations

The original study dates from 1986 when the GCS was adapted for pediatric use by James.

Subsequent validation studies have been performed on cohorts of patients with blunt head trauma or other types of infant trauma.

The pGCS was found to be as efficient in evaluating and tracking a patient’s mental status in its target population as the standard adult version.

The scale was found to have relatively lower accuracy in identifying traumatic brain injury on CT than the standard version. Also, in the original study, only 36% of subjects have been examined by CT, thus not knowing for sure whether all patients ruled out from traumatic brain injury by the scale, did not have any traumatic findings.

Another limitation is that given by the age 2 threshold, thus the scale is only addressed to preverbal pediatric populations.

 

Original source

James HE. Neurologic evaluation and support in the child with an acute brain insult. Pediatr Ann. 1986; 15(1):16-22.

Validation

Borgialli DA, Mahajan P, Hoyle JD Jr, Powell EC, Nadel FM, Tunik MG, Foerster A, Dong L, Miskin M, Dayan PS, Holmes JF, Kuppermann N; Pediatric Emergency Care Applied Research Network (PECARN). Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. Acad Emerg Med. 2016; 23(8):878-84.

Other references

1. 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(1):30-3.

2. Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. Performance of the pediatric Glasgow coma scale in children with blunt head trauma. Acad Emerg Med. 2005; 12(9):814-9.

3. 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 Syst. 1991; 7(4):183-90.


App Version: 1.0.1

Coded By: MDApp

Specialty: Pediatrics

Objective: Evaluation

Type: Scale

No. Of Variables: 3

Year Of Study: 1986

Abbreviation: pGCS

Article By: Denise Nedea

Published On: June 16, 2017 · 08:02 AM

Last Checked: June 16, 2017

Next Review: June 16, 2018