The Pittsburgh Brain Stem Score (PBSS) can be used to assess brain stem reflexes in a comatose patient.
Brain Stem Reflex
Finding
Points
lash reflex
present either side
2
absent both sides
1
corneal reflex
present either side
2
absent both sides
1
doll's eye and/or ice water calorics
present either side
2
absent both sides
1
right pupil reaction to light
present
2
absent
1
left pupil reaction to light
present
2
absent
1
gag and/or cough reflex
present
2
absent
1
(see Table 3 Schuster and Dick, page 33; Table 3 BRCT II, page 530)
Pittsburgh brain stem score =
= SUM(points for reflexes)
Interpretation:
• minimum score: 6
• maximum score: 12
• The higher the score, the better.
• The PBSS may be added to the Glasgow Coma score to give a combined Glasgow-Pittsburgh Coma Score. With the above configuration to the PBSS, the combined score would have a range of 9 - 27.
Variations:
• In the Brain Resuscitation Clinical Trial, the lash and corneal reflex appear to represent a single scored parameter.
• In Edgren et al a modified Pittsburgh score (undefined) is reported to have a best score of 20 and a worst score of 4.
To read more or access our algorithms and calculators, please log in or register.
