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Arch Dis Child 1997;77:519-521 ( December )

Development of a modified paediatric coma scale in intensive care clinical practice

A Tatman,a A Warren,a A Williams,b J E Powell,c W Whitehouseb

a The Birmingham Children's Hospital NHS Trust: Department of Intensive Care, b Department of Paediatric Neurology, c Department of Public Health and Epidemiology, University of Birmingham

Correspondence to: Dr W Whitehouse, Department of Paediatric Neurology, Birmingham Children's Hospital, Ladywood Middleway, Birmingham B16 8ET.


Accepted 22 August 1997

James' adaptation of the Glasgow coma scale (JGCS) was designed for young children. Intubated patients are not allocated a verbal score, however, so important changes in a patient's conscious level may be missed. A grimace score was therefore developed and assessed for use in intubated children.
  Two observers made a JGCS observation within 15 minutes of each other. One observer was the patient's nurse and the other a trained investigator. Interobserver reliability was determined between the first and second observation for each component of the scale. Reliability was measured using kappa  and weighted kappa  statistics.
  Seventy three children had 104 sets of observations. Interobserver reliability was moderate to good for all components, with the grimace score better than the verbal score.
  It is concluded that the grimace score is more reliable than the verbal score and may be useful in intubated patients in whom the verbal score cannot be used.

Keywords: coma scale; intensive care; conscious level

© 1997 by Archives of Disease in Childhood


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