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Indian Journal of Trauma and Emergency Pediatrics

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Role of Modified Glasgow Coma Scale in Pediatric Non-traumatic Coma

M.B. Koujalgi , M.B. Koujalgi , A.C. Basavaraj , M.D. Balaji , Vindhya Palled

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Indian Journal of Trauma and Emergency Pediatrics 4(3):p 89-93, July - September 2012. | DOI:

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Abstract

Objective: To assess the utility of Modified Glasgow Coma Scale (MGCS) in pediatric non-traumatic coma and to predict the immediate outcome. Design: Prospective observational study. Setting: PICU of tertiary care teaching and referral hospital. Study group: Consecutive children (n=100) between 5 months to 15 years with acute non-traumatic coma. Methodology: MGCS and brainstem reflexes were assessed at 6 hourly intervals for 72 hours from the time of admission. The lowest score of the MGCS and worst brainstem reflexes were used for the analysis. Outcome measure: Survival or death. Results: The likelihood of death in patients with MGCS score <8 was much higher than when MGCS score was ³8, with odds ratio 21.4% and p<0.001. Among the individual components of MGCS, lower ocular response scores (p<0.001) and motor response scores (p<0.001) were better predictors than verbal response scores (p-0.01). Absence of one or more brainstem reflexes was associated with adverse outcomes and death (p<0.001). There was statistically significant correlation between MGCS and brainstem reflexes in predicting the immediate outcome with spearman correlation coefficient of +0.724 with p<0.01. Conclusion: Ocular, motor response scores and brainstem reflexes were more predictive of the short term outcome than the total MGCS scores. A score incorporating ocular response, motor response and brainstem reflexes needs to be evaluated to assess the outcome in non-traumatic coma in the pediatric population.

Keywords: Coma; Glasgow Coma Scale; Outcome. 

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