One of the components of the Glasgow coma scale is the best verbal response, which cannot be assessed in nonverbal small children. A modification of the original Glasgow coma scale was created for children too young to talk.
Parameters:
(1) eyes opening
(2) best verbal or nonverbal response (depending on development status)
(3) best motor response
|
Eye Opening
|
Score
|
|
spontaneously
|
4
|
|
to verbal stimuli
|
3
|
|
to pain
|
2
|
|
never
|
1
|
|
Nonverbal Child
|
Verbal Child's Best Verbal Response (Glasgow coma scale)
|
Score
|
|
smiles, oriented to sound, follows objects, interacts
|
oriented and converses
|
5
|
|
consolable when crying and interacts inappropriately
|
disoriented and converses
|
4
|
|
inconsistently consolable and moans; makes vocal sounds
|
inappropriate words
|
3
|
|
inconsolable, irritable and restless; cries
|
incomprehensible sounds
|
2
|
|
no response
|
no response
|
1
|
|
Best Motor Response
|
Score
|
|
obeys commands
|
6
|
|
localizes pain
|
5
|
|
flexion withdrawal
|
4
|
|
abnormal flexion (decorticate rigidity)
|
3
|
|
extension (decerebrate rigidity)
|
2
|
|
no response
|
1
|
Additional markers associated with prognosis:
(1) oculovestibular reflex (all children with absent reflexes died; 50% of children with impaired reflex died; 25% with normal reflexes died)
(2) abnormal pupillary response (77% with bilateral fixed and dilated pupils died)
(3) intracranial pressure (pressures > 40 torr with CCS scores of 3, 4 or 5 was inevitably fatal)
children's coma scale =
= (score for eye opening) + (score for best nonverbal or verbal response) + (score for best motor response)
Interpretation:
• minimum score is 3, which has the worst prognosis
• maximum score is 15, which has the best prognosis
• Scores of 7 or above have a good chance for recovery.
• Scores of 3-5 are potentially fatal, especially if accompanied by fixed pupils or absent oculovestibular responses or elevated intracranial pressure.
• Normal children under 5 years may have lower scores than adults because of reduced best verbal and motor responses.
