Inconsistency in the Application of Glasgow Coma Scale in Pediatric Patients

• Published in: Medical principles and practice Vol. 33; no. 1; pp. 41 - 46
• Main Authors: Caruana, Maria, Hackenbruch, Sophie Noelle, Grech, Victor, Farrugia, Ruth
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.02.2024
• Subjects: Adolescent; Adult; Adults; Age; Child; Children & youth; Consciousness; Emergency medical care; Glasgow Coma Scale; Humans; Nurses; Nursing; Original Paper; Pain; Patients; Pediatrics; Physicians; Questionnaires; Response rates; Surveys and Questionnaires; Pediatrics; Glasgow Coma Scale; Glasgow Coma Score
• ISSN: 1011-7571; 1423-0151; 1423-0151
• DOI: 10.1159/000534797

Abstract Objective: The Glasgow Coma Scale (GCS) is widely used to objectively describe the extent of patients’ impaired consciousness. However, there are known variations in scoring GCS both in adults and children which may impact patient management. The aim of this audit was to assess the application of GCS by medical and nursing staff in pediatric medical patients. Subject and Methods: An online questionnaire was distributed amongst doctors and nurses working in the Department of Child and Adolescent Health at Mater Dei Hospital in Malta. The participants assigned GCS for 8 case scenarios involving children of different ages with varying levels of consciousness. Results were analyzed by calculating percentage agreement and by Cronbach’s alpha. Results: Sixty-six participants were studied, with a response rate of 52%. Performance was poor overall, with Cronbach alpha 0.53. Correlation was better at the upper and lower ends of the scale and the worst performance was for verbal response. Only respondents with 5–10 years of experience achieved acceptable consistency in the application of the GCS (Cronbach alpha 0.78). Conclusion: There is considerable variation in application of GCS in pediatric patients, highlighting the need for education and training to improve consistency for this commonly used neurological assessment tool. Highlights of the StudyThere are known variations of scoring the Glasgow Coma Scale in both adults and children, and these may impact management.There is considerable variation in the application of Glasgow Coma Scale in pediatric patients, highlighting the need for education and training to improve consistency for this commonly used neurological assessment tool.