Pediatric Glasgow Coma Scale (pGCS)
- Category: General
- Version: v1.0.1
- Reviewed: Reviewed 6 Sep 2026
- Validation: Validation pending
Total = E (1–4) + V (1–5) + M (1–6), each component scored as the best observed age-appropriate response, giving a range of 3–15. No zero exists. Each verbal and motor level pairs the verbal-child descriptor with its infant or preverbal equivalent, and the option labels here are neutral paraphrases; GCS wording is stewarded by RCPS Glasgow / Teasdale. The total is read against the conventional TBI tri-band, which is adult-derived: 3–8 severe, 9–12 moderate, 13–15 mild.
Paediatric literature notes that a total of 5 or less may identify severe injury more accurately in young children, and a reassuring total does not rule out intracranial injury in infants. Two lineages with different age cutoffs exist: James/PECARN (preverbal <2 y vs ≥2 y) and BPNA ‘Child’s GCS’ (<5 y vs >5 y). Totals are not comparable across schemes unless the scheme and age band are recorded with each score. Intubation breaks the plain sum: BPNA records V as a non-numeric ‘T’ (hence the grimace score, Tatman 1997), while some US practice records V=1 with a ‘T’ suffix. This score computes a plain E+V+M and does not model ‘T’. [NEEDS SOURCE]: no canonical rule for numerically substituting V=1 in the James/PECARN branch. Sedation or paralysis makes V and M uninformative; flag such scores.
| Result | Interpretation |
|---|---|
| < 9 | 3 to 8 — Conventionally categorized as the 'severe' range in GCS-based TBI severity stratification. This tri-band originated in adult work; pediatric literature notes a threshold of 5 or less may identify severe injury more accurately in young children. |
| 9 to <13 | 9 to 12 — Conventionally categorized as the 'moderate' range in GCS-based TBI severity stratification. Descriptive only; interpret in the full clinical context. |
| ≥ 13 | 13 to 15 — Conventionally categorized as the 'mild' range in GCS-based TBI severity stratification. A reassuring total does not rule out intracranial injury, which is a documented limitation in infants. |
References
- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–84.Original adult GCS: source of the ordinal levels, the E+V+M sum (3–15), and the best-response rule.PMID 4136544DOI 10.1016/s0140-6736(74)91639-0
- Reilly PL, Simpson DA, Sprod R, Thomas L. Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale. Childs Nerv Syst. 1988;4(1):30–33.Adelaide paediatric adaptation with age-related expected responses.PMID 3135935DOI 10.1007/BF00274080
- James HE. Neurologic evaluation and support in the child with an acute brain insult. Pediatr Ann. 1986;15(1):16–22.James adaptation (the 'J' in JGCS); James/PECARN lineage.PMID 3951884DOI 10.3928/0090-4481-19860101-05
- Tatman A, Warren A, Williams A, Powell JE, Whitehouse W. Development of a modified paediatric coma scale in intensive care clinical practice. Arch Dis Child. 1997;77(6):519–521.Grimace score for intubated children (no verbal score); feeds the BPNA revision.PMID 9496188DOI 10.1136/adc.77.6.519
- British Paediatric Neurology Association. Child's Glasgow Coma Scale (Revised BPNA 2001). Audit chart.UK standard scale; <5 y vs >5 y bands, plus the 'C' (eyes closed) and 'T' (intubated) non-numeric codes.Source
- Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. Performance of the pediatric Glasgow Coma Scale in children with blunt head trauma. Acad Emerg Med. 2005;12(9):814–819.First validation; <2 y age cut-off for the pediatric column.PMID 16141014DOI 10.1197/j.aem.2005.04.019
- Borgialli DA, Mahajan P, Hoyle JD Jr, et al; PECARN. Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. Acad Emerg Med. 2016;23(8):878–884.Large PECARN validation (n=42,041); <2 y vs ≥2 y split.PMID 27197686DOI 10.1111/acem.13014
- Jain S, Iverson LM. Glasgow Coma Scale. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.Secondary reference: James/PECARN descriptor layout, <2 y vs >2 y age cut-off, and the 13–15/9–12/3–8 severity tri-band.Source
Reproduction rights
Freely reproducible.The scoring math is an ordinal sum (E+V+M, 3–15) — a method/idea, not copyrightable expression. The numeric levels and severity thresholds are facts. GCS descriptor wording is stewarded by the Royal College of Physicians and Surgeons of Glasgow (associated with Sir Graham Teasdale) via glasgowcomascale.org; pediatric descriptors are reproduced freely across open sources (StatPearls NBK513298, CHOP pathway, BPNA audit chart). This implementation uses NEUTRAL PARAPHRASES rather than verbatim stewarded wording and attributes stewardship here and in notes (pgcs.md IP status).
Independent clinical validation: pending
Two independent clinical validators will be named here once review is complete.
- 2026-09-03v1.0.0Initial releaseInitial published text.
- 2026-09-06v1.0.1ClarificationAdded a one-line description for the catalogue card. No rule, threshold or reference changed.
Other general scores
- APLS age-based weight estimateAge-based weight estimate for when a child cannot be weighed
- Body surface areaBody surface area from height and weight, for mg/m² dosing and cardiac index
- Corrected QT intervalHeart-rate-corrected QT interval by Bazett and Fridericia
- FOUR scoreComa assessment that stays complete in an intubated patient
- Ideal body weightIdeal body weight from height, by four published methods side by side
Important. For use by qualified health professionals as an informational and educational aid. It supports clinical judgment and does not replace it. Verify every result independently before making a clinical decision. This is not a medical device.