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.

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.