Publication: Comparison of Alert, Response to Verbal Stimulus, Response to Pain, Unresponsive (AVPU) Scale with Pediatric Glasgow Coma Scale for Assessing Level of Consciousness in Infants and Children
Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Altered consciousness is a neurological emergency in pediatrics, with high morbidity
and mortality. The Pediatric Glasgow Coma Scale (pGCS) is commonly used to assess
altered sensorium in children. The Alert, Verbal, Pain, Unresponsive (AVPU) scale is a
simple and easy-to-use alternative assessment tool that records patient response to
verbal, painful stimuli, and unresponsiveness.
Objective
To compare the effectiveness of the Alert, Verbal, Pain, Unresponsive with the
pediatric glasgow coma scale in assessing conscious level in infant and children with
altered sensorium.
Method
This hospital-based observational study was conducted in Kanti Children’s Hospital,
Maharajgunj, Kathmandu Nepal, for 12 months. All children aged from 2 months
to 14 years with altered sensorium in the emergency department and pediatric
intensive care unit (PICU), who met inclusion criteria, were enrolled and assessed
using AVPU and pGCS scales.
Result
The study included 55 cases, with a male-to-female ratio of 1.2:1. Most cases (60%)
were under 5 years old, with a mean age of 2.16 years. Infectious origin was the most
common etiology (64%), where meningitis was the most common diagnosis (38%).
AVPU and pGCS scores varied based on patient response: A/V/P/U of AVPU scale
corresponded with mean pGCS score of 14, 12.5, 9.29 and 3.80 respectively.
Conclusion
After the statistically comparison, it was significantly easier to use AVPU scale for
assessing conscious level in infants and children at peripheral and tertiary centers
with busy emergency departments as compared to the pGCS scale.
KEY WORDS
Alert, response to verbal stimulus, response to pain, unresponsive scale (AVPU),
Glasgow coma scale, Level of consciousness, Pediatric glasgow coma scale
Description
Prakash B,1 Shrestha NJ,2 Prakash K,3 Sah SK,4 Prakash P,5 Raymajhi A6
1Department of Pediatrics
Madhesh Institute of Health Sciences
Janakpur, Nepal
2Department of Pediatrics
Kanti Children Hospital, Kathmandu, Nepal
3Department of General Practice and Emergency Medicine
Patan Academy of Health Sciences
Lalitpur, Nepal
4Department of Community Medicine
KIST Medical College and Teaching Hospital
Lalitpur, Nepal
5Janaki Medical College and Teaching Hospital
Janakpur, Nepal
6Department of Pediatrics
Kanti Children Hospital, Kathmandu, Nepal
Keywords
Alert, response to verbal stimulus, response to pain, unresponsive scale (AVPU), Glasgow coma scale, Level of consciousness, Pediatric glasgow coma scale