Blantyre coma scale

The Blantyre coma scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children. It was designed by Drs. Terrie Taylor and Malcolm Molyneux in 1987, and named for the Malawian city of Blantyre, site of the Blantyre Malaria Project.

History

The scale was first developed in 1988 by Graham and colleagues at the Queen Elizabeth Central Hospital in Blantyre, Malawi, and has since been widely used in low-resource settings.

Criteria

The BCS assesses three criteria: eye opening, verbal response, and motor response. Each criterion is scored on a scale of 0 to 5, with a total possible score of 15. The scores are then used to classify the level of consciousness as follows:

• Mild impairment: 12-15
• Moderate impairment: 8-11
• Severe impairment: <8

Eye opening

1. Eye opening is assessed by evaluating the child's response to a visual or auditory stimulus. A score of 1 is given if the child opens their eyes spontaneously, a score of 2 if they open their eyes in response to a sound, a score of 3 if they open their eyes in response to a pain stimulus, and a score of 4 if they do not open their eyes at all.

Verbal response

1. Verbal response is assessed by evaluating the child's response to verbal stimuli. A score of 1 is given if the child makes a normal sound or cry, a score of 2 if they make an abnormal sound or cry, a score of 3 if they only respond to pain, and a score of 4 if they do not respond at all.

Motor response

1. Motor response is assessed by evaluating the child's response to a pain stimulus. A score of 1 is given if the child moves spontaneously, a score of 2 if they move in response to a pain stimulus, a score of 3 if they have abnormal posturing, and a score of 4 if they have no response.

Clinical utility

The BCS has been shown to be a reliable and valid tool for assessing the level of consciousness in young children. It is easy to administer and does not require any specialized equipment or training. The BCS has been used in numerous studies evaluating the effectiveness of treatments for conditions such as cerebral malaria, meningitis, and traumatic brain injury.

Modifications

The BCS has been modified in some settings to better suit local conditions. For example, in a study conducted in Nigeria, a modified BCS was used that added a criterion for assessing the child's ability to follow simple commands. This modification was found to improve the sensitivity of the BCS in identifying children with impaired consciousness.

Limitations

While the BCS is a useful tool for assessing the level of consciousness in young children, it is important to note that it is not a diagnostic tool and should be used in conjunction with other clinical assessments. Additionally, the BCS may not be appropriate for use in children with pre-existing neurological conditions or developmental delays.

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