Most health care practitioners can accurately assess a person’s GCS without thinking about it, but bring in a child, and a paediatric GCS is often harder to perform. So, how do you assess a child’s GCS?
Like the adult Glasgow Coma Scale, the paediatric Glasgow Coma Scale is considered a reasonably reliable, observable assessment tool for documenting the conscious state or neurological response of a person post traumatic brain injuries. In pre-hospital care, there is still a certain level of debate about the overall benefits of performing a GCS on a patient versus a more basic level of consciousness assessment such as AVPU.
Paediatric Glasgow Coma Scale
The following are recognised paediatric GCS scores:
Best eye response: (E)
4. Eyes opening spontaneously
3. Eye opening to speech
2. Eye opening to pain
1. No eye opening
Best verbal response: (V)
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)
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
Any combined score of less than eight represents a significant risk of mortality. Accurately assessing a paediatric GCS is often difficult for paramedics who do not work in an area where they treat a lot of children and their basic diagnostic skills are often lacking. It is therefore even more important to understand the paediatric GCS tool.