ED Pathway for Evaluation/Treatment of Acute Head Trauma

Modified Glasgow Coma Scale for Infants and Children

AREA ASSESSED INFANTS CHILDREN SCORE*
EYE OPENING Open spontaneously Open spontaneously 4
Open in response to verbal stimuli Open in response to verbal stimuli 3
Open in response to pain only Open in response to pain only 2
No response No response 1
VERBAL RESPONSE Coos and babbles Oriented, appropriate 5
Irritable cries Confused 4
Cries in response to pain Inappropriate words 3
Moans in response to pain Incomprehensible words or nonspecific sounds 2
No response No response 1
MOTOR RESPONSE** Moves spontaneously and purposefully Obeys commands 6
Withdraws to touch Localizes painful stimulus 5
Withdraws in response to pain Withdraws in response to pain 4
Responds to pain with decorticate posturing (abnormal flexion) Responds to pain with flexion 3
Responds to pain with decerebrate posturing (abnormal extension) Responds to pain with extension 2
No response No response 1

*Score:
12 suggests a severe head injury
8 suggests need for intubation and ventilation
6 suggests need for intracranial pressure monitoring

**If the patient is intubated, unconscious, or preverbal, the most important part of this scale is motor response. This section should be carefully evaluated.