Assessment of consciousness

scores for assess level of consciousness in children

1. Assessment of consciousness
Marwa Elhady
lecturer of pediatrics
Alazhar University
2016

2. STIMULUS RESPONSE
Assessment of level of consciousness
start softly and then more
loudly
Level of consciousness is the most sensitive indicator of
changes in the neurological state of the patient

3. Rapid assessment but Rough method,
not suitable for long follow up

5. Useful tool for grading of the altered consciousness
and the severity of CNS insult.
Used for adults and older children and modified to
be used in infants and young children.
Glasgow coma scale

8. Disadvantages:
* Inability to assess any parameter will make it impossible to count the score:
* Eye opening cannot be assessed if the eyes are swollen and closed (trauma).
* Verbal response cannot be assessed in intubated and ventilated patients.

9. Classification of Brain Injury according to GCS
MILD
GCS 13-15
MODERATE
GCS 9-12
SEVERE
GCS 3-8
(HICKEY 2003)
Patient is considered comatose if the GCS ≤
8/15

10. FOUR score (Full Outline of UnResponsiveness) (2005)
The FOUR score is a modification of GCS
Eliminates the verbal response
Adds brain stem functions
It tests cortical and brainstem separately.

11. Motor response (cortical function)
Spontaneous 6
Flexion withdrawal to touch 5
Flexion withdrawal to pain 4
Decorticate extension to pain 3
Decerebrate extension to pain 2
No response (flaccidity) 1
Modified Morray coma score for children (1984)
Advantages: Can be used in intubated and mechanically ventilated patients.
now replaced by FOUR score
Brainstem reflexes (brainstem function)
– Pupillary reflex
– Corneal reflex
– Oculocephalic reflex
– Cough/gag reflex
All normal 4
Some absent or diminished 3
All absent but breathing 2
All absent and apneic 1
Total score is 10 (6+4).

12. Thank you