Action
Calculate Pediatric GCS (>2 yo)
- MD Calc (opens browser window)
Eye Opening | Open spontaneously | 4 |
Open to verbal stimuli | 3 | |
Open to pain only | 2 | |
No response | 1 | |
Verbal Response | Oriented / appropriate | 5 |
Confused | 4 | |
Inappropriate words | 3 | |
Incomprehensible words / sounds | 2 | |
No response | 1 | |
Motor Response | Obeys commands | 6 |
Localizes pain | 5 | |
Withdraws to pain | 4 | |
Flexor posturing to pain | 3 | |
Extensor posturing to pain | 2 | |
No response | 1 |
Children with a GCS score <14 have a higher risk of injury and are treated more conservatively
Decision
Are any of the following high risk criteria present?
- GCS Score = 14
- Note GCS <14 see background below
- Signs of basilar skull fracture
- Other signs of altered mental status
- Agitation
- Somnolence
- Repetitive questioning
- Slow response to verbal communication
Yes
- 4.3% risk of clinically important traumatic brain injury (ciTBI)
- 14.0% of population
- CT recommended
Background
“For the purposes of this review, we will consider mTBI as a brain injury with a GCS of ≥14 and concussion as a type of mTBI. The choice of GCS score cutoff is based upon criteria used by the Pediatric Emergency Care Applied Research Network (PECARN), which evaluated 42,412 children with mTBI to determine the risk of clinically important TBI (ciTBI) in a low-risk setting. mTBI was defined by GCS scores of ≥14. Of note, patients with a GCS score of ≤13 had a nearly 20% chance of severe TBI, significantly higher than those with a GCS score of 14 to 15, and thus the decision by the many researchers was to not include that group in mTBI.”
Low Risk Findings (>2 yo)