Background: Glasgow Coma Scale (GCS) is the gold standard for neurological assessment in traumatic head injury. Limitations to GCS include variations in rater reliability, test setting and sedation/intubation. Serial Neurological Assessments in Pediatrics (SNAP) was designed to standardize neurological assessment. We examined the efficacy of SNAP for earlier detection of acute neurological decompensation. Methods: Retrospective analysis identified patients with acute neurological decline (drop in GCS of >2 in 1 hour). We reviewed GCS and SNAP (calculated using neurological consultant notes) scores 48 hours prior to decline. Slopes were calculated for each score over time. Results: Four patients were eligible, with > 2 GCS and SNAP scores available for calculation. Average slopes for GCS were 1.3, -0.8, 1.6 and 2.1 for eyes, voice, motor, and total GCS, respectively, and -2.6, 0, -2.3, -2.4, -2.4, -2.0, -2.8 and -11.9 for mental status, cranial nerve, communication, left and right upper extremities, left and right lower extremities, and total SNAP score, respectively. Conclusions: All aspects of the SNAP score had negative and steeper slopes prior to neurological decline, whereas only ‘voice’ in GCS had a negative trend. These findings suggest that the SNAP tool may be useful in earlier identification of acute decline. Ongoing prospective studies are underway.