The Pittsburgh Brain Stem Score (PBSS) can be used to assess brain stem reflexes in a comatose patient.
Brain Stem Reflex
present either side
absent both sides
doll's eye and/or ice water calorics
right pupil reaction to light
left pupil reaction to light
gag and/or cough reflex
(see Table 3 Schuster and Dick, page 33; Table 3 BRCT II, page 530)
Pittsburgh brain stem score =
= SUM(points for reflexes)
• 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.
• 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.
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Purpose: To use the Pittsburgh Brain Stem Score to evaluate a patient with possible coma.
Objective: severity, prognosis, stage