Question:
Following trauma, an 18 months baby was brought to the casualty. She opens her eyes spontaneously, gives an irritable cry, and withdraws all four limbs to pinch. What is her GCS score?
Following trauma, an 18 months baby was brought to the casualty. She opens her eyes spontaneously, gives an irritable cry, and withdraws all four limbs to pinch. What is her GCS score?
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In the Pediatric GCS, an "irritable cry" scores a 4 on the verbal scale, while normal "cooing/babbling" is required for a perfect 5. Withdrawing from painful stimuli (like a pinch) scores a 4 on the motor scale.
Updated On: Sep 3, 2026
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The Correct Option is D
Solution and Explanation
Concept:
The clinician needs to calculate the correct Glasgow Coma Scale (GCS) score for an 18-month-old infant based on a specific set of physical exam findings following trauma.
This requires applying the modified Pediatric Glasgow Coma Scale (pGCS), designed specifically for pre-verbal children under the age of 2 years.
Explanation:
• The standard adult GCS assesses Eye opening (E), Verbal response (V), and Motor response (M). For pre-verbal infants, the criteria for Verbal and Motor responses are modified to accurately reflect age-appropriate developmental milestones.
• Eye Opening (E): Maximum score of 4.
- Spontaneous = 4.
- To speech/sound = 3.
- To pain = 2.
- None = 1.
The clinical vignette states the baby opens her eyes spontaneously, so E = 4.
• Verbal Response (V): Maximum score of 5 for infants.
- Smiles, coos, babbles normally = 5.
- Irritable cry, but consolable = 4.
- Cries persistently to pain, inconsolable = 3.
- Moans/grunts to pain = 2.
- None = 1.
The vignette states the baby gives an irritable cry, so V = 4.
• Motor Response (M): Maximum score of 6 for infants.
- Normal spontaneous movement = 6.
- Withdraws to touch = 5.
- Withdraws to pain (pinch) = 4.
- Abnormal flexion to pain (decorticate posture) = 3.
- Abnormal extension to pain (decerebrate posture) = 2.
- None = 1.
The vignette states the baby withdraws all four limbs to a pinch (painful stimulus), so M = 4.
• Total Calculation: Total pGCS = E + V + M = 4 + 4 + 4 = 12.
Final Answer:
Based on the pediatric modifications, the calculated Glasgow Coma Scale score is 12.
The clinician needs to calculate the correct Glasgow Coma Scale (GCS) score for an 18-month-old infant based on a specific set of physical exam findings following trauma.
This requires applying the modified Pediatric Glasgow Coma Scale (pGCS), designed specifically for pre-verbal children under the age of 2 years.
Explanation:
• The standard adult GCS assesses Eye opening (E), Verbal response (V), and Motor response (M). For pre-verbal infants, the criteria for Verbal and Motor responses are modified to accurately reflect age-appropriate developmental milestones.
• Eye Opening (E): Maximum score of 4.
- Spontaneous = 4.
- To speech/sound = 3.
- To pain = 2.
- None = 1.
The clinical vignette states the baby opens her eyes spontaneously, so E = 4.
• Verbal Response (V): Maximum score of 5 for infants.
- Smiles, coos, babbles normally = 5.
- Irritable cry, but consolable = 4.
- Cries persistently to pain, inconsolable = 3.
- Moans/grunts to pain = 2.
- None = 1.
The vignette states the baby gives an irritable cry, so V = 4.
• Motor Response (M): Maximum score of 6 for infants.
- Normal spontaneous movement = 6.
- Withdraws to touch = 5.
- Withdraws to pain (pinch) = 4.
- Abnormal flexion to pain (decorticate posture) = 3.
- Abnormal extension to pain (decerebrate posture) = 2.
- None = 1.
The vignette states the baby withdraws all four limbs to a pinch (painful stimulus), so M = 4.
• Total Calculation: Total pGCS = E + V + M = 4 + 4 + 4 = 12.
Final Answer:
Based on the pediatric modifications, the calculated Glasgow Coma Scale score is 12.
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