Beyond Coma Scales

Children who experience an acute brain injury are often comatose, either from direct insult to the brain's centers that control awareness and arousal or because of receiving CNS depressing medications or both. Whether a child will emerge from their comatose state depends on numerous factors including the etiology and severity of their brain injury, age, comorbid medical conditions, and the impact of neuroprotective therapies. Disorders of consciousness (DoC) are clinical states classified based on the degree of wakefulness, awareness of oneself or their environment, and signs of consciousness and communication. Vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) are DoC that children may manifest as they recover from their acute brain injury. Accurately identifying a child's DoC has implications for neuroprognostication and guiding neurorestorative therapies.