Modified Glasgow Coma Scale and Brainstem Reflexes in Predicting Survival and Outcome in Children with Non-Traumatic Coma: A Descriptive Study

Abstract

Background: The modified Glasgow Coma Scale (MGCS), in spite of its various drawbacks has been widely used for assessing pediatric coma, though only few studies are available to support its use in pediatric coma as a whole.. This study is to evaluate the relation between Modified Glasgow coma scale and Brainstem reflexes in predicting survival and outcome in children with non-traumatic coma.  

Materials and Methods: A hospital based descriptive study among 100 consecutive children of 5 months to 15 years with non-traumatic coma admitted in paediatric intensive care unit (PICU) of a tertiary care teaching hospital, during the period of January 2006 to January 2007.  

Results: Individual components of modified Glasgow Coma Scale (MGCS) were analysed with individual scores. It showed that low individual scores were associated with adverse outcome (death in acute non-traumatic coma). Those children with score of <8 was more prone for adverse outcome in terms of death with significant association (P<.001). Brainstem reflex score was found to be a better predictor of outcome in terms of death in patients with acute non-traumatic coma. The score of more than 2 is predictive of better outcome (P=<0.001).  

Conclusion: MGCS scoring is simple, easy, can be applied at bed side and does not need any investigations. Its application in developing countries like India with limited investigative and intensive care facilities can help treating pediatrician to decide regarding management or referral and counseling the parents regarding probable outcome.