The Telco Coma Scale

To the Editor: A recent American study found that in 2009, girls aged 14–17 years sent an average of 112 text messages per day.1 Australian teenagers are no different. During a ward round earlier this year, I saw three teenage girls in a row in various stages of recovery from acute asthma. Despite the best efforts of the team, none of the teenagers spoke; the management of their conditions was discussed with their parents instead. However, the teenagers were clearly still awake, often giggling and actively texting, with their ubiquitous mobile phones tightly gripped in their hands.

This phenomenon of the non-talking teenage girl who is actively texting during the bedside consultation has continued throughout 2011. A new way to assess the neurological examination of teenage girls that takes into account their level of interaction with their mobile phone is required. Based loosely on the standard neurological examination and Glasgow Coma Scale,2 I have developed the Telco Coma Scale to assist doctors and nurses in the neurological assessment of teenage girls addicted to the use of their mobile phone.

Normal orientation in time, place and person in the new scale means that the teenager is able to send text messages, respond to Facebook alerts, and demonstrate a variety of facial expressions in response to the messages received. Despite an absence of verbal response to any surrounding adult and an intense flexion reflex that makes it impossible to remove the mobile phone from the hand, the treating health care professional can be reassured that this is the equivalent of a Glasgow Coma Scale score of 15 and that the teenager is fully conscious.

Deep tendon reflexes are measured by the speed at which that the teenager is able to type text messages. Sensory and pain responses are accurately assessed by measuring the response time to Facebook alerts and observing the teenager’s facial expressions.

The measurement of power requires the resident to attempt to remove the phone from the teenager’s hand. A normal flexion and power response is demonstrated by the teenager being able to successfully pull a resident of greater than their own body weight off balance rather than give up the phone. In my experience, the mobile phone has never once been able to be removed from the grasp of a normal teenage girl.