Pediatric Glasgow Coma Scale (pGCS)

• Infants with head trauma, altered mental status or neurologic abnormalities.
• Use in initial and serial assessments.

• The Pediatric Glasgow Coma Scale (pGCS) allows providers to obtain, track and communicate the mental status and level of consciousness in preverbal children (≤2 years of age).
• Variation of the standard Glasgow Coma Scale (GCS) with age appropriate modifications to the motor and verbal components.
• Scored 3-15 (eye, verbal and motor response) like the standard GCS
• Should be reported as a sum and include the scores of each of the individual components because of the difference in prognostic value and variations of individual components versus the summed score. Example: Total pCGS 12=E3+V4+M5. (Healey C 2003)
• As accurate for identifying clinically important traumatic brain injury (ciTBI) as GCS in verbal children.

Points to keep in mind:

• Best to obtain pGCS prior to the administration of analgesics or other interventions that could alter the score.
• Somewhat less accurate in identifying those with ANY traumatic brain injury (TBI) on CT compared to the GCS in older children. (Borgialli DA 2016)
• In intubated patients (for whom the verbal score may not be obtained), consider using the Full Outline of UnResponsiveness (FOUR score). This is a validated, expanded scoring system. (Wijdicks EF 2005) (Sadaka F 2012)
• Distinction between normal and abnormal flexion may be challenging, especially for the non-specialist. (Reilly 1991)

• Allows for calculation of the GCS in preverbal children, for whom some of the components in the standard GCS are not able to be measured.
• The standard GCS is a component of several prognostic and clinical decision making tools such as the PECARN Pediatric Head Injury/Trauma Algorithm, Revised Trauma Score, Age Specific Pediatric Trauma Score, and the Canadian CT Head Injury/Trauma Rule.