Development of a modified paediatric coma scale in intensive care clinical practice
a The Birmingham Children's Hospital NHS Trust:
Department of Intensive Care, b Department of Paediatric Neurology, c Department of Public Health and
Epidemiology, University of Birmingham
Correspondence to: Dr W Whitehouse, Department of Paediatric Neurology, Birmingham Children's Hospital, Ladywood Middleway, Birmingham B16 8ET.
Accepted 22 August 1997
James' adaptation of the Glasgow coma scale (JGCS) was
designed for young children. Intubated patients are not allocated a verbal score, however, so important changes in a patient's conscious level may be missed. A grimace score was therefore developed and assessed for use in intubated children.
Two observers made a JGCS observation within 15 minutes of each
other. One observer was the patient's nurse and the other a trained
investigator. Interobserver reliability was determined between the
first and second observation for each component of the scale.
Reliability was measured using 
and weighted statistics.
Seventy three children had 104 sets of observations. Interobserver
reliability was moderate to good for all components, with the grimace
score better than the verbal score.
It is concluded that the grimace score is more reliable than the
verbal score and may be useful in intubated patients in whom the verbal
score cannot be used.
© 1997 by Archives of Disease in Childhood
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