• Pediatric Glasgow Coma Scale Ppt
• Paediatric Gcs
• Pediatric Glasgow Coma Scale Score
• Pediatric Glasgow Coma Scale Explained

• Glasgow Coma Scale Eye Opening Response • Spontaneous--open with blinking at baseline 4 points • To verbal stimuli, command, speech 3 points • To pain only (not applied to face) 2 points • No response 1 point Verbal Response.
• Glasgow Coma Scale-Adult, Peds,Infant. Acute Care 30: Glasgow Coma Scale—Adult, Pediatric, Infant. Eye Opening: Infant (Pediatric (>1 year) Adult.
• Glasgow Coma Scale Score in Pediatric Patients with Traumatic Brain Injury. Critical score of Glasgow Coma Scale for pediatric traumatic.
• The Pediatric Glasgow Coma Scale (GCS) and the Pediatric Trauma Scale (PTS) meet these criteria. Their use will improve quality of care services and reduce the delay between the time of the evaluation, the investigation and.
• Aug 05, 2013  Glasgow Coma Scale Score in Pediatric Patients with Traumatic Brain Injury; Limitations and Reliability Fariborz Ghaffarpasand, 1, * Ali Razmkon, 2 and Maryam Dehghankhalili 3 1 Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
• Impact of Glasgow Coma Scale score and pupil parameters on mortality rate and outcome in pediatric. Tripartite Stratification of the Glasgow Coma Scale.

“Forty years since it was first described, the Glasgow Coma Scale has become an integral part of clinical practice and research across the World. We have now devised a new structured approach to assessment to improve the accuracy, reliability and communication of the Scale. Glasgow Coma Scale Assessment Aid available as PDF.

Traumatic brain injuries in pediatrics are among the most common causes of pediatric emergency room visits and is usually associated with long-term disability and neurological sequelae []. Despite advances in prevention, diagnosis and management of traumatic brain injuries, the mortality and morbidity rates are high among pediatric population []. The epidemiological studies have revealed that alls, motor vehicle accidents and recreational activities are the most common causes of traumatic brain injuries in pediatrics [,]. The management of moderate to severe traumatic brain injuries include prolonged intensive care and rehabilitation although the prognosis and the outcome remains elusive. Thus, several scoring systems have been introduced and validated in order to determine the outcome of the pediatric patients with traumatic brain injuries []. Several factors have been reported to be related to the patient outcome including age, the duration of the coma, the type of the brain lesion, the pattern of the pupils, injury severity score, the motor patterns, impaired reflexes of the brain stem, hypotension, hypoxia and the Glasgow Coma Scale (GCS) []. Some laboratory and paraclinical investigations have also been used to predict the outcome including brainstem auditory evoked potentials and cognitive event-related potentials []. For instance, it has been shown that event-related potentials such as N400 could be reliably used to predict the post-traumatic language skills (subcortical and cortical systems) in those with severe traumatic brain injury suffering from aphasia [].

Several lines of evidence suggest that pediatric patients suffering from severe traumatic brain injury have better prognosis when compared to adults []. In other words, the recovery of pediatric patients with traumatic brain injury is significantly better than adults []. In addition, it has been demonstrated that younger children have better outcome compared to older ones []. The later fact, however, is a controversial issue while some studies have shown that younger children have worst prognosis after traumatic brain injuries []. Younger children have incomplete myelinization which makes them more susceptible to shearing injury []. It was shown that pediatric patients older than 6 years have better motor and cognitive function after traumatic brain injury []. The prognosis and mechanism of injury of the central nervous system depends extensively on the patients’ age at the time injury. This makes it hard for the physicians to predict the outcome of traumatic brain injury in pediatric population. Thus predicting the outcome of traumatic brain injury in pediatrics is of important value both clinically and morally [].

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The Glasgow Coma Scale (GCS) score is the most commonly and widely used indicator of severity of traumatic brain injury in both adults and pediatrics []. GCS is also used to predict the outcome of brain injuries []. The GCS score less than 8 is referred to 'severe traumatic brain injury' which is associated with less favorable outcome and poor recovery []. Although the GCS is reliable in adult population, the reliability remain elusive in pediatrics. This is because the scoring system is based on the consciousness and patients' understanding of the orders and commends which is not applicable to pediatrics. Thus some modifications have been made in the GCS scoring system in order to be suitable for the children as well as neonates. Vray 3.0 for 3ds max 2011 64 bit free download. In pediatrics another important issue that should be kept in mind when predicting the outcome is the hypoxic-ischemic insult at the time of injury which could be considered confounding factors in calculating GCS score and assessing the outcome []. In order to adjust the GCS scoring system for pediatrics, it has been suggested that the cut-off value be set at 5 as severe traumatic brain injury. In other words, the threshold for neurophysiologic dysfunction should be decreased in pediatric population []. It has also been reported that precise calculation of GCS is a reliable indicator of the patients’ outcome [,]. It has been reported by Lai et al. [] that the mortality rate was higher for traumatic brain injury children with GCS scores of 3-5 than those with scores greater than 5. Children with GCS scores of 3-5 subsequently died or developed severe disabilities, whereas those with a GCS score more than 5 had better outcomes []. Bruce et al. found that a GCS more than 5 was always associated with excellent recovery []. It has also been reported that the decision making for performing decompressive craniectomy in pediatric population should be based on the GCS scoring and brain CT-scan findings []. However this point should be kept in mind that the cut-off value for pediatrics should be decreased to 5 in order to be able to assess good reliability.

Taking all these together, this should be mentioned that GCS score is the most feasible, accessible and reliable predictor of traumatic brain injury outcome in pediatrics and despite its shortcomings, could be adjusted for this group. The cut-off value for severe traumatic injury should be set as 5 instead of 8 in order to be able to predict the outcome more precisely.

References

Pediatric Glasgow Coma Scale Ppt

The Glasgow Coma Scale (GCS) is a neurologicalscale which aims to give a reliable and objective way of recording the state of a person's consciousness for initial as well as subsequent assessment. A person is assessed against the criteria of the scale, and the resulting points give a person's score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used modified or revised scale).

GCS was initially used to assess a person's level of consciousness after a head injury, and the scale is now used by emergency medical services, nurses, and physicians as being applicable to all acute medical and trauma patients. In hospitals, it is also used in monitoring patients in intensive care units.

The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, both professors of neurosurgery at the University of Glasgow's Institute of Neurological Sciences at the city's Southern General Hospital.

GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system. The initial indication for use of the GCS was serial assessments of people with traumatic brain injury^[1] and coma for at least six hours in the neurosurgical ICU setting, though it is commonly used throughout hospital departments. The similar Rancho Los Amigos Scale, is used to assess the recovery of traumatic brain injury.

GCS was updated following a review of the helpfulness and usefulness of the scale from clinicians. It was decided that several things required updating, like the Eye Response element, meaning that instead of responding to 'Painful Stimuli' being regarded as a 2, a person that opens their eyes in response to pressure is now considered a 2 in the Eye Response element.^[2]

• 1Elements of the scale
• 6References

Elements of the scale[edit]

Note that a motor response in any limb is acceptable.^[4]The scale is composed of three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (graded 1 in each element) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Eye response (E)[edit]

There are four grades starting with the most severe:

1. No opening of the eye
2. Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the lunula area of the person's fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect).^[5]
3. Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such people receive a score of 4, not 3.)
4. Eyes opening spontaneously

Verbal response (V)[edit]

There are five grades starting with the most severe:

1. No verbal response
2. Incomprehensible sounds. (Moaning but no words.)
3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.)
4. Confused. (The person responds to questions coherently but there is some disorientation and confusion.)
5. Oriented. (Person responds coherently and appropriately to questions such as the person’s name and age, where they are and why, the year, month, etc.)

Motor response (M)[edit]

There are six grades:

1. No motor response
2. Decerebrate posturing accentuated by pain (extensor response: adduction of arm, internal rotation of shoulder, pronation of forearm and extension at elbow, flexion of wrist and fingers, leg extension, plantarflexion of foot)
3. Decorticate posturing accentuated by pain (flexor response: internal rotation of shoulder, flexion of forearm and wrist with clenched fist, leg extension, plantarflexion of foot)
4. Withdrawal from pain (absence of abnormal posturing; unable to lift hand past chin with supraorbital pain but does pull away when nailbed is pinched)
5. Localizes to pain (purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supraorbital pressure applied)
6. Obeys commands (the person does simple things as asked)

Interpretation[edit]

https://ninix.netlify.app/ps4-emulator-download-without-survey.html. Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form 'GCS 9 = E2 V4 M3 at 07:35'.

Generally, brain injury is classified as: Arturia v collection 3 rapidshare files.

• Severe, GCS < 8–9
• Moderate, GCS 8 or 9–12 (controversial)^[6]
• Minor, GCS ≥ 13.

Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached (e.g. 'E1c', where 'c' = closed, or 'V1t' where t = tube). Often the 1 is left out, so the scale reads Ec or Vt. A composite might be 'GCS 5tc'. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for 'abnormal flexion'.

The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently, the Paediatric Glasgow Coma Scale was developed for assessing younger children.

Revisions[edit]

• Glasgow Coma Scale: While the 15-point scale is the predominant one in use, this is in fact a modification and is more correctly referred to as the Modified Glasgow Coma Scale. The original scale was a 14-point scale, omitting the category of 'abnormal flexion'. Some centres still use this older scale, but most (including the Glasgow unit where the original work was done) have adopted the modified one.
• The Rappaport Coma/Near Coma Scale made other changes.
• Meredith W., Rutledge R, Fakhry SM, EMery S, Kromhout-Schiro S have proposed calculating the verbal score based on the measurable eye and motor responses.
• The most widespread revision has been the Simplified Motor and Verbal Scales which shorten the respective sections of the GCS without loss of accuracy.^[7]
• The GCS for intubated people is scored out of 10 as the verbal component falls away

Controversy[edit]

The GCS has come under pressure from some researchers who take issue with the scale's poor inter-rater reliability and lack of prognostic utility.^[8] Although there is no agreed-upon alternative, newer scores such as the Simplified motor scale and FOUR score have also been developed as improvements to the GCS.^[9] Although the inter-rater reliability of these newer scores has been slightly higher than that of the GCS, they have not gained consensus as replacements.^[10]

See also[edit]

• AVPU scale

References[edit]

1. ^Teasdale G, Jennett B (1974). 'Assessment of coma and impaired consciousness. A practical scale'. Lancet. 2 (7872): 81–4. doi:10.1016/S0140-6736(74)91639-0. PMID4136544.
2. ^'What's new - Glasgow Coma Scale'. www.glasgowcomascale.org. Retrieved 2018-06-24.
3. ^Russ Rowlett. 'Glasgow Coma Scale'. University of North Carolina at Chapel Hill.
4. ^Hutchinson’s clinical methods 22nd edition
5. ^Iankova, Andriana (2006). 'The Glasgow Coma Scale: clinical application in Emergency Departments'. Emergency Nurse. 14 (8): 30–5. doi:10.7748/en2006.12.14.8.30.c4221. PMID17212177.
6. ^'Resources data'(PDF). www.cdc.gov.
7. ^Gill M, Windemuth R, Steele R, Green SM (2005). 'A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes'. Ann Emerg Med. 45 (1): 37–42. doi:10.1016/j.annemergmed.2004.07.429. PMID15635308.
8. ^Green S. M. (2011). 'Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale'. Annals of Emergency Medicine. 58 (5): 427–430. doi:10.1016/j.annemergmed.2011.06.009. PMID21803447.
9. ^Iver, VN; Mandrekar, JN; Danielson, RD; Zubkov, AY; Elmer, JL; Wijdicks, EF (2009). 'Validity of the FOUR score coma scale in the medical intensive care unit'. Mayo Clinic Proceedings. 84 (8): 694–701. doi:10.4065/84.8.694. PMC2719522. PMID19648386.
10. ^Fischer, M; Rüegg, S; Czaplinski, A; Strohmeier, M; Lehmann, A; Tschan, F; Hunziker, PR; Marschcorresponding, SC (2010). 'Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study'. Critical Care. 14 (2): R-64. doi:10.1186/cc8963. PMC2887186. PMID20398274.

Paediatric Gcs

Sources[edit]

Pediatric Glasgow Coma Scale Score

• Teasdale G, Murray G, Parker L, Jennett B (1979). 'Adding up the Glasgow Coma Score'. Acta Neurochir Suppl (Wien). 28 (1): 13–6. doi:10.1007/978-3-7091-4088-8_2. ISBN978-3-7091-4090-1. PMID290137.
• Meredith W, Rutledge R, Fakhry SM, Emery S, Kromhout-Schiro S (1998). 'The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores'. J Trauma. 44 (5): 839–44, discussion 844–5. doi:10.1097/00005373-199805000-00016. PMID9603086.

Pediatric Glasgow Coma Scale Explained