CHOP Infant Coma Scale ("Infant Face Scale"): A novel coma scale for children less than two years of age

The Glasgow Coma Scale (GCS) is the most frequently used tool worldwide for assessing the severity of neurologic injury after brain trauma, although a pplying this scale to infants and younger children can be problematic. The CHOP Infant Coma Scale, or Infant Face Scale (IFS), is a novel scale for ch ildren under 2 years of age which differs from other pediatric coma scales in the following ways: (1) it relies on objective behavioral observations; (2) it assesses cortical as well as brainstem function; (3) it parallels th e GCS in scoring but is based on infant-appropriate behaviors; and (4) it c an be applied to intubated patients. We report the results of a prospective study designed to compare interrater reliability between the IFS and GCS i n children less than 2 years of age. Seventy-five hospitalized children les s than 2 years of age were assessed simultaneously by a pair of observers, representing a spectrum of health care professionals, who scored the childr en using both the IFS and GCS, Interrater reliability for each pair of obse rvers for each scale was assessed using the kappa (kappa) statistic. A seco nd series of 10 infants in the intensive care unit with specific diagnoses of acute traumatic or hypoxic/ischemic brain injury were similarly assessed . In the 75 hospitalized infants with a variety of diagnoses, interrater re liability for the GCS was in the "almost perfect," "slight," and '"fair" ra nge for the eye-opening, motor, and verbal subtests, respectively. In contr ast, the IFS showed interrater reliability in the "almost perfect," "substa ntial," and "almost perfect" ranges for the three subtests, When applied to infants in an intensive care unit with acute traumatic brain injury or hyp oxia/ischemia, the GCS interrater reliability scores were in the "fair" ran ge, while the IFS scores were in the "almost perfect" range, The IFS demons trates improved interrater reliability in direct comparison to the GCS, par ticularly in the "verbal/face" component where most pediatric coma scales a re deficient, The IFS may prove to be a simple and practical bedside index of brain injury severity in children less than two years of age.