Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Save your unit preferences in settings!

    Pediatric Glasgow Coma Scale (pGCS)

    Assesses impaired consciousness and coma in pediatric patients.
    Favorite

    INSTRUCTIONS

    Use for children 2 years and younger only. For older children, use the standard Glasgow Coma Scale (GCS). Note the difference between the Glasgow Coma Score (total score, only applicable when all three components are testable) and the Glasgow Coma Scale (component scores, applicable if any of three components is not testable).

    When to Use
    Pearls/Pitfalls
    Why Use
    • 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)
    ≤2 years
    >2 years

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    • The score can be used to assess and track a patient’s mental status and level of consciousness. However, like the standard GCS, the score alone is not sufficient to guide diagnosis or management. (Teasdale 2014)

    Management

    • Although a valuable diagnostic tool, the score alone should not be used for management decisions in the acute setting.
    • Common applications include the need to consider intubation/definitive airway management in those with a GCS less than 8. However, the entire clinical picture must be taken into account.
    • Due in part to the value in identifying those with ciTBIs, any patient with an abnormal GCS warrants close assessment and monitoring.

    Critical Actions

    • All patients with a GCS <15 need appropriate monitoring.
    • All patients with concern for mental status or neurologic compromise should be closely monitored and reassessed.
    Content Contributors
    • Joyce Brown, MD
    Reviewed By
    • Matthew Meigh, DO
    About the Creator
    Dr. Graham Teasdale
    Partner Content
    Content Contributors
    • Joyce Brown, MD
    Reviewed By
    • Matthew Meigh, DO