Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury

Lieh-Lai, Mary; Theodorou, Andreas; Sarnaik, Ashok P.; Meert, Kathleen L.; Moylan, Patricia M.; Canady, Alexa

doi:10.1016/s0022-3476(05)80426-3

Cited by 145 publications

(56 citation statements)

References 16 publications

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“…Finally, our results confirm that GCS represents the most accurate scoring system for evaluating the severity of head injury, although other studies have shown some limitations of GCS in predicting the outcome of traumatized children [30, 31]. The results of our study show that an initial low GCS score, multiple trauma, brain edema and coagulation abnormalities, including delayed aPTT, elevated FDP, low fibrinogen and decreased platelet count, represent important predictors of a poor outcome in children with head injury.…”

Section: Discussionsupporting

confidence: 82%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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Background: Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, their effect on clinical outcome remains unclear, particularly among children. Objectives: To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury. Study Design: We conducted a prospective observational study among 60 children with head injury, immediately evaluating severity of head injury (Glasgow Coma Scale, GCS); cerebral axial tomography; prothrombin time; activated partial thromboplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, we applied the Glasgow Outcome Score (GOS). Associations with GOS were evaluated using univariate and multivariate logistic models. Results: Among children with severe head injury, 22.2% (6/27) developed DIC, all of whom died and had shown severe brain edema. Among those with severe head injury yet without DIC, the mortality was only 14.2%. A low GOS was significantly and independently associated with a low GCS, multiple trauma, delayed aPTT, low fibrinogen level, elevated FDP and low platelet count. Brain edema was also associated with a low GOS, though not significantly. Conclusions: In addition to GCS, type of trauma, type of brain lesion and certain coagulation abnormalities are predictors of GOS.

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Section: Discussionsupporting

confidence: 82%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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“…The classic definition of mild TBI is a Glasgow Coma Score (GCS) of 13-15, moderate TBI is a GCS of 9-12 and children with GCS scores ^ 8 are considered to have severe TBI [38] . Even with modification for pediatric use, the GCS is not an accurate predictor of cognitive outcome in children [39,40] . The number of lesions on brain computerized tomography as well as the length of time to first purposeful motor response have also been used to predict outcomes and may prove to be more sensitive to pediatric injury [40,41] .…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Outcomes of Pediatric Traumatic Brain Injury

Keenan

Bratton²

2006

Dev Neurosci

227

138

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Traumatic brain injury is a leading cause of death and disability in the pediatric age group. Causes of injury vary with child developmental age, with more inflicted injuries in infants, fall-related injuries among toddlers, sports-related injuries among middle-school-aged children and motor vehicle crashes in older children. Prevention strategies exist for some pediatric traumatic brain injury; however, all suffer from lack of compliance and enforcement. Neuropsychological and behavioral outcomes for injured children vary with the severity of injury, child age at injury, premorbid child characteristics, family factors and the families’ socioeconomic status. Each of these factors needs to be taken into account when designing rehabilitation strategies and assessing factors related to outcome.

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“…Because the Glasgow Coma Score (GCS) alone is an insensitive way of characterizing the heterogeneous group of pediatric patients with minor head injury, 32,[38][39][40] we created the clinical variable "abnormal mental status." We considered abnormal mental status to be present if the patient had a GCS or pediatric GCS 41 of Ͻ15 or if the patient was confused, somnolent, repetitive, or slow to respond to verbal communication.…”

Section: Variable Definitionsmentioning

confidence: 99%

Does an Isolated History of Loss of Consciousness or Amnesia Predict Brain Injuries in Children After Blunt Head Trauma?

Palchak¹,

Holmes²,

Vance³

et al. 2004

Pediatrics

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ABSTRACT. Background. A history of loss of consciousness (LOC) is frequently used as an indication for cranial computed tomography (CT) in the emergency department (ED) evaluation of children with blunt head trauma.Objective. We sought to determine whether an isolated LOC and/or amnesia is predictive of traumatic brain injury (TBI) in children with blunt head trauma.Methods. We prospectively enrolled children <18 years old presenting to a level I trauma center ED between July 1998 and September 2001 with blunt head trauma. We evaluated the association of LOC and/or amnesia with 1) TBI identified on CT and 2) TBI requiring acute intervention. We defined the latter by a neurosurgical procedure, antiepileptic medication for >1 week, persistent neurologic deficits, or hospitalization for >2 nights. We then investigated the association of LOC and/or amnesia with TBI in those patients without other symptoms or signs of TBI ("isolated" LOC and/or amnesia).Results. Of eligible children, 2043 (77%) were enrolled, 1271 (62%) of whom underwent CT; 1159 (91%) of these 1271 had their LOC and/or amnesia status known. A total of 801 (39%) of the 2043 enrolled children had a documented history of LOC and/or amnesia. Of the 745 with documented LOC and/or amnesia who underwent CT, 70 (9.4%; 95% confidence interval [CI]: 7.4%, 11.7%) had TBI identified on CT versus 11 of 414 (2.7%; 95% CI: 1.3%, 4.7%) without LOC and/or amnesia (difference: 6.7%; 95% CI: 4.1%, 9.3%). Of the 801 children known to have had LOC and/or amnesia (regardless of whether they underwent CT), 77 (9.6%; 95% CI: 7.7%, 11.9%) had TBI requiring acute intervention versus 11 of 1115 (1%; 95% CI: 0.5%, 1.8%) of those without LOC and/or amnesia (difference: 8.6%; 95% CI: 6.5%, 10.7%). For those with an isolated LOC and/or amnesia without other signs or symptoms of TBI, however, 0 of 142 (95% CI: 0%, 2.1%) had TBI identified on CT, and 0 of 164 (95% CI: 0%,1.8%) had TBI requiring acute intervention.Conclusions. Isolated LOC and/or amnesia, defined by the absence of other clinical findings suggestive of TBI, are not predictive of either TBI on CT or TBI requiring acute intervention. Elimination of an isolated LOC and/or amnesia as an indication for CT may decrease unnecessary CT use in those patients without an appreciable risk of TBI. Pediatrics 2004;113:e507-e513. URL: http://www.pediatrics.org/cgi/content/full/113/6/e507; traumatic brain injury, loss of consciousness and/or amnesia, CT, cranial tomography, emergency department evaluation, children.ABBREVIATIONS. TBI, traumatic brain injury; ED, emergency department; CT, computed tomography; LOC, loss of consciousness; GCS, Glasgow Coma Score; CI, confidence interval. T raumatic brain injury (TBI) is the leading cause of death due to trauma in children, 1-5 resulting in ϳ3000 deaths as well as 50 000 hospitalizations and 650 000 emergency department (ED) visits per year in the United States. 1-3 Cranial computed tomography (CT) is the diagnostic test of choice for evaluating children with blunt head trauma in the ED...

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Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury

Cited by 145 publications

References 16 publications

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

Epidemiology and Outcomes of Pediatric Traumatic Brain Injury

Does an Isolated History of Loss of Consciousness or Amnesia Predict Brain Injuries in Children After Blunt Head Trauma?

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