Glasgow Coma Scale (GCS) Assessment in Pediatrics

Introduction

• GCS is assessed during the primary survey in trauma resuscitation.
• Reassessment timings:
  • At minute five of trauma resuscitation.
  • Before the patient leaves the code room.
  • When there is a notable change in mental status.

GCS Assessment Examples

Infant (Eight-month-old)

• Observations:
  • Eyes open spontaneously.
  • Infant is interacting and babbling.
  • Normal spontaneous movement.
• GCS Evaluation:
  • Eyes: Open spontaneously - Score: 4
  • Verbal: Cooing, babbling - Score: 5
  • Motor: Has spontaneous movement - Score: 6
• Total GCS Score: 15

Child (Four-year-old)

• Observations:
  • Eyes open spontaneously.
  • Child is aware, interacting appropriately, and following directions.
• GCS Evaluation:
  • Eyes: Open spontaneously - Score: 4
  • Verbal: Interactive and appropriate - Score: 5
  • Motor: Obeys commands - Score: 6
• Total GCS Score: 15

Adolescent (Ten-year-old)

• Observations:
  • Eyes initially closed; opens eyes when spoken to.
  • Interacts with resident, appears confused but answers questions.
  • Not following commands; responds to pain.
• GCS Evaluation:
  • Eyes: Open to voice - Score: 3
  • Verbal: Disoriented but responding - Score: 4
  • Motor: Localizes pain but doesn't obey commands - Score: 5
• Total GCS Score: 12

Tips for Accurate GCS Assessment

• Use the GCS poster available in the code room for guidance.
• When unsure, ask for help from senior surgical residents, fellows, or ED physicians.
• Ensure all parts of the GCS are called out loud during assessment for clarity.

Conclusion

• Obtaining a reliable GCS in infants and children can be challenging.
• Accurate assessment is crucial for effective trauma resuscitation.