Head injuries in infants and young children: the value of the Paediatric Coma Scale

Review of literature and report on a study


The normal verbal and motor responses embodied in the standard Glasgow Coma Scale (GCS) are not achievable during the first few years of life. The recent literature contains numerous reports of attempts to devise scales of responses quantitating the conscious level in infants and young children, both for research purposes and as clinical guides; some of these scales incorporate items, e.g. brainstem reflexes, that are not included in the GCS. We have reported on a simple paediatric version of the GCS, which uses the standard scale with minor modifications in the verbal component, and sets realistic age-related normal responses. This has been tested prospectively in a series of 60 head-injured infants and children (age range 0–72 months). Of 6 cases recorded as comatose 6 h after injury, 4 have confirmed or suspected residual disabilities. Of 35 cases considered to be fully conscious at 6 h, 31 have made good recoveries and only 1 has suspected residual disabilities. The study suggests that the scale accords with the realities of neurological immaturity, and confirms that it can be used in routine paediatric practice. For comparative therapeutic trials, the conscious level in infants has limited value as an index of brain injury, and should be complemented by other indices, such as brainstem reflexes.

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  1. 1.

    Allan D, Culne-Seymour C (1989) Paediatric coma scale. Nurs Times 85:44–45

    Google Scholar 

  2. 2.

    Andre-Thomas Chesni Y, Dargassies SS-A (1960) The neurological examination of the infant. (Little Club clinics in developmental medicine, no 1). National Spastics Society, London

    Google Scholar 

  3. 3.

    Bruce DA (1983) Clinical care of the severely head injured child. In: Shapiro K (ed) Pediatric head trauma. Futura, Mt Kisco, NY, pp 27–44

    Google Scholar 

  4. 4.

    Bruce DA, Schut L, Bruno LA, Wood JH, Sutton LN (1978) Outcome following severe head injuries in children. J Neurosurg 48:679–688

    Google Scholar 

  5. 5.

    Bruce DA, Radhaely RC, Goldberg AI, Zimmerman RA, Bilaniuk LT, Schut L, Kuhl DE (1979) The pathophysiology, treatment and outcome following severe head injury in children. Child's Brain 5:174–191

    Google Scholar 

  6. 6.

    Dekaban A (1970) Neurology of early childhood. Williams & Wilkins, Baltimore

    Google Scholar 

  7. 7.

    Duncan CC, Ment LR, Smith B, Ehrenkranz RA (1981) A scale for the assessment of neonatal neurologic status. Child's Brain 8:299–306

    Google Scholar 

  8. 8.

    Gesell A, Halverson HM, Thompson H, Ilg FL, Gastner BM, Bates LB, Amatruda CS (1940) The first five years of life. A guide to the study of the preschool child. Harper, New York

    Google Scholar 

  9. 9.

    Gordon NS, Fois A, Jacobi G, Minns RA, Seshia SS (1983) Consensus statement: the management of the comatose child. Neuropediatrics 14:3–5

    Google Scholar 

  10. 10.

    Griffiths R (ed) (1954) The abilities of babies: a study in mental measurement. Lowe and Brydone, Thetford

    Google Scholar 

  11. 11.

    Griffiths R (ed) (1970) The abilities of young children: a comprehensive system of mental measurement for the first eight years of life. Young and Son, Chard

    Google Scholar 

  12. 12.

    Hahn YS, Chyung C, Barthel MJ, Bailes J, Flannery AM, McLone D (1988) Head injuries in children under 36 months of age. Child's Nerv Syst 4:34–39

    Google Scholar 

  13. 13.

    Humphreys RP (1983) Outcome of severe head injury in children. Concepts Pediatr Neurosurg 3:190–201

    Google Scholar 

  14. 14.

    Humphreys RP, Jaimovich R, Hendrick EB, Hoffman HJ, (1983) Severe head injuries in children. Concepts Pediatr Neurosurg 4:230–242

    Google Scholar 

  15. 15.

    Illingworth RS (1966) The development of the infant and young child. Normal and abnormal, 3rd edn. Livingstone, Edinburgh London

    Google Scholar 

  16. 16.

    Ingraham FD, Matson DD (1954) Neurosurgery of infancy and childhood. Thomas, Springfield, Ill

    Google Scholar 

  17. 17.

    Jane JA (1989) Definitions. In: Hoff JT, Anderson TE, Cole TM (ed) Mild to moderate head injury. (Contemporary issues in neurological surgery, 1). Blackwell, Oxford, pp 3–8

    Google Scholar 

  18. 18.

    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet I:480–484

    Google Scholar 

  19. 19.

    Jennett B, Teasdale G (1981) Management of head injuries. Davis, Philadelphia

    Google Scholar 

  20. 20.

    Medical Research Council Brain Injuries Committee (1941) A glossary of psychological terms commonly used in cases of head injury. HM Stationery Office, London

    Google Scholar 

  21. 21.

    Molloy CJ, McCaul KA, McLean AJ, North JB, Simpson DA (1990) Extradural haemorrhage in infancy and childhood. A review of 35 years' experience in South Australia. Child's Nery Syst 6:383–387

    Google Scholar 

  22. 22.

    Morray JP, Tyler DC, Jones TK, Shintz JT, Lemire RJ (1984) Coma scale for use in brain-injured children. Crit Care Med 12:1018–1020

    Google Scholar 

  23. 23.

    Moyson FR, Podevain A (1970) Le traumatisme cranio-cérébral de l'enfant. Presses Academiques Européenes, Brussels

    Google Scholar 

  24. 24.

    Prechtl H, Beintema D (1964) The neurological examination of the full-term newborn infant. Heinemann, London

    Google Scholar 

  25. 25.

    Raimondi AJ (1988) Editorial comment. Child's Nerv Syst 4:39–40

    Google Scholar 

  26. 26.

    Raimondi AJ, Hirschauer J (1984) Head injury in the infant and toddler. Coma scoring and outcome scale. Child's Brain 11:12–35

    Google Scholar 

  27. 27.

    Reilly PL, Simpson DA, Sprod R, Thomas L (1988) Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale. Child's Nerv Syst 4:30–33

    Google Scholar 

  28. 28.

    Saleman M, Schepp RS, Ducker TB (1981) Calculated recovery rates in severe head trauma. Neurosurgery 8:301–308

    Google Scholar 

  29. 29.

    Seshia SS, Seshia MMK, Sachdeva RK (1977) Coma in childhood. Dev Med Child Neurol 19:614–628

    Google Scholar 

  30. 30.

    Shapiro K (1985) Head injury in children. In: Becker DP, Povlishock JT (eds) Central nervous system trauma. Status report-1985. National Institute of Health, Washington, DC, pp 243–253

    Google Scholar 

  31. 31.

    Simpson DA, Reilly PL (1982) Paediatric coma scale (Letter). Lancet II:450

    Google Scholar 

  32. 32.

    Teasdale G (1975) Acute impairment of brain function. I. Assessing “conscious level”. Nurs Times 71:914–917

    Google Scholar 

  33. 33.

    Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet II:81–84

    Google Scholar 

  34. 34.

    Teasdale G, Galbraith S, Clarke K (1975) Acute impairment of brain function. II. Observation record chart. Nurs Times 71:972–973

    Google Scholar 

  35. 35.

    Till K (1975) Paediatric neurosurgery. Blackwell, Oxford

    Google Scholar 

  36. 36.

    Walker ML, Mayer TA, Storrs BB, Hylton PD (1985) Pediatric head injury — factors which influence outcome. Concepts Pediatr Neurosurg 6:84–87

    Google Scholar 

  37. 37.

    Yager JV, Johnston B, Seshia SS (1990) Coma scales in pediatric practice. Am J Dis Child 144:1088–1091

    Google Scholar 

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Correspondence to D. A. Simpson.

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Simpson, D.A., Cockington, R.A., Hanieh, A. et al. Head injuries in infants and young children: the value of the Paediatric Coma Scale. Child's Nerv Syst 7, 183–190 (1991). https://doi.org/10.1007/BF00249393

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Key words

  • Paediatric head injuries
  • Coma scale