DEVELOPMENT OF A MODIFIED PEDIATRIC COMA SCALE IN INTENSIVE-CARE CLINICAL-PRACTICE

James' adaptation of the Glasgow coma scale (JGCS) was designed for yo ung children. Intubated patients are not allocated a verbal score, how ever, so important changes in a patient's conscious level may be misse d. A grimace score was therefore developed and assessed for use in int ubated children. Two observers made a JGCS observation within 15 minut es of each other. One observer was the patient's nurse and the other a trained investigator. Interobserver reliability was determined betwee n the first and second observation for each component of the scale. Re liability was measured using K and weighted K statistics. Seventy thre e children had 104 sets of observations. Interobserver reliability was moderate to good for all components, with the grimace score better th an the verbal score. It is concluded that the grimace score is more re liable than the verbal score and may be useful in intubated patients i n whom the verbal score cannot be used.