Coma scales in pediatric practice

Article Abstract:

A widely used method to assess the status of patients in comas is the Glasgow Coma Scale (GCS). The scale includes a 14-point assessment and has been used primarily in adults with head trauma. However, the grading of neurodevelopmental function in adults is not necessarily applicable to children, and the use of the GCS for classifying comatose children may not be sufficiently accurate. To further investigate this, six different coma scales were used to assess 15 comatose children who ranged in age from 2 months to 17 years. Accurate classification of coma is necessary to select the most appropriate treatment and to determine prognosis. Special attention was given to interobserver variability. The evaluations were made by two physicians using the following six instruments: the GCS, the Simpson and Reilly Scale, the Children's Coma Score, the Children's Orthopedic Hospital and Medical Center Scale, the Jacobi Scale, and the 0 to IV Scale. Variations in the observations of the two physicians were evaluated using disagreement rate and the kappa statistic; the results of the two methods were similar. Disagreement rates ranged from 0.03 to 0.20 for different items on the various scales. Overall, the disagreement rate for items on the following three scales was 0.10 or less: the 0 to IV Scale, the Simpson and Reilly Scale, and the Jacobi scale. It was concluded that these three scales are the most suitable for the assessment of comatose children. The high rate of interobserver agreement for these measurements suggests that they are suited for pediatric use, but these findings require confirmation using a larger number of subjects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Prognosis, Identification and classification, Coma, Coma (Medicine), Pediatric neurology, Glasgow coma scale

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Advising parents to stop smoking: opportunities and barriers in pediatric practice

Article Abstract:

The Surgeon General has stated that pediatricians are in a unique position to convince parents to stop smoking because they see the family on a regular basis. Although many women stop smoking to protect their unborn children, they often resume smoking after the baby is born. To see whether pediatricians are concerned with telling their patients to stop smoking, 139 physicians in Maine responded to a mailed questionnaire. Most pediatricians (91 percent) reported they advised their patients to quit smoking, but the average time spent on counseling was five minutes. Many pediatricians (94 percent) advised parents about the negative effects smoking has on their family (passive smoking). Only 46 percent of the pediatricians felt secure about suggesting methods by which the parents could stop smoking. Barriers to advising parents to stop smoking were that parents are not expecting to talk about smoking during pediatric visits, and time constraints. The majority of pediatricians would welcome methods of giving advice to parents about smoking cessation. Pediatricians can enhance the no-smoking effort by incorporating smoking cessation methods for parents during routine family visits. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Prevention, Beliefs, opinions and attitudes, Smoking, Patient education, Pediatricians, Smoking and women, Women smokers

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