Pediatric Glasgow Coma Scale (pGCS)
- CategoryGeneral
- Versionv1.0.0
- Reviewed2026-07-25
- ValidationIndependent clinical validation: pending
Total pGCS = E + V + M, the ordinal sum of the eye-opening (E, 1–4), verbal/vocal (V, 1–5), and motor (M, 1–6) components, each taken as the best observed age-appropriate response; the total therefore ranges 3–15 with no 0 (Teasdale & Jennett 1974). There are no physical units and components are never interpolated. The single total is stratified into the conventional TBI-severity tri-band: 3–8 ('severe'), 9–12 ('moderate'), and 13–15 ('mild').
Two lineages with different age cut-offs exist: James/PECARN (preverbal <2 y vs verbal ≥2 y, per Holmes 2005 / Borgialli 2016) and BPNA 'Child's GCS' (<5 y vs >5 y). A total is not comparable across schemes unless the scheme and age band are recorded — pin and store both per case. The E/V/M option labels here are neutral paraphrases spanning both the verbal-child and infant/preverbal descriptor columns; exact GCS wording is stewarded by the Royal College of Physicians and Surgeons of Glasgow / Teasdale (glasgowcomascale.org). Intubation breaks the plain sum: BPNA records the verbal component as a non-numeric 'T' (which is why the grimace score was introduced, 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] a single canonical rule for numerically substituting V=1 for intubated verbal in the James/PECARN branch (primary sources describe the code, not an arithmetic substitution). The 13–15/9–12/3–8 tri-band originated in adult TBI work; pediatric literature refines the 'severe' cut downward (≤5) for young children (StatPearls NBK513298). Sedation/paralysis makes V and M uninformative — flag such scores. Further [NEEDS SOURCE]: the original Reilly 1988 Adelaide per-level age-expected table and the James & Trauner 1985 chapter pagination were not independently verified from primary full text.
| 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.
- 2026-07-25v1.0.0Initial releaseInitial release: Pediatric GCS (E+V+M, 3–15) with paraphrased age-adapted option labels and conventional severity bands.