Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a rating score for head injury and the score gives an indication of degree of injury and level of consciousness. Table A.14 has been modified for children by the Adelaide Women’s and Children’s Hospital, as the response scores are usually lower in children. Children between 6 months and 2 years may localize pain but not obey commands, and before 6 months, the best score is withdrawal from pain or abnormal extension and flexion. There is no modification of the adult eye-opening scale. Verbal responses should be consistent with age.
Outcomes
In children with GCS scores of 3 or 4, there are significant mortality rates (between 20% and 70%), whereas in those with scores over 5, there is low mortality and morbidity (<30%). If a child does not die within the first 24 h, the risk of death falls to between 10% and 20%. Some 64% of children who do not open their eyes spontaneously within 24 h will die or survive in a vegetative state. It is important to note that over 90% of children who are comatose initially with a GCS score >3 will recover to an independent state, although 50% will have neurological impairment. If coma persists for longer than 3 months, there is almost always neurological and cognitive damage.