Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma

the Pediatric Emergency Care Applied Research Network (PECARN)

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma. Methods: This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children <2 years old and the standard GCS for those ≥2 years old. Outcomes were TBI visible on CT and clinically important TBI (ciTBI), defined as death from TBI, neurosurgery, intubation for more than 24 hours for the head injury, or hospitalization for 2 or more nights for the head injury in association with TBI on CT. We compared the areas under the receiver operating characteristic (ROC) curves between age cohorts for the association of GCS and the TBI outcomes. Results: We enrolled 42,041 patients, of whom 10,499 (25.0%) were <2 years old. Among patients <2 years, 313/3,329 (9.4%, 95% confidence interval [CI] = 8.4% to 10.4%) of those imaged had TBIs on CT and 146/10,499 (1.4%, 95% CI = 1.2% to 1.6%) had ciTBIs. In patients ≥2 years, 773/11,977 (6.5%, 95% CI = 6.0% to 6.9%) of those imaged had TBIs on CT and 572/31,542 (1.8%, 95% CI = 1.7% to 2.0%) had ciTBIs. For the pediatric GCS in children <2 years old, the area under the ROC curve was 0.61 (95% CI = 0.59 to 0.64) for TBI on CT and 0.77 (95% CI = 0.73 to 0.81) for ciTBI. For the standard GCS in older children, the area under the ROC curve was 0.71 (95% CI = 0.70 to 0.73) for TBI on CT scan and 0.81 (95% CI = 0.79 to 0.83) for ciTBI. Conclusions: The pediatric GCS for preverbal children was somewhat less accurate than the standard GCS for older children in identifying those with TBI on CT. However, the pediatric GCS for preverbal children and the standard GCS for older children were equally accurate for identifying ciTBI.

Original languageEnglish (US)
Pages (from-to)878-884
Number of pages7
JournalAcademic Emergency Medicine
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2016

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Glasgow Coma Scale
Craniocerebral Trauma
Pediatrics
Tomography
Confidence Intervals
ROC Curve
Traumatic Brain Injury
Neurosurgery
Intubation
Multicenter Studies
Hospital Emergency Service
Hospitalization
Cohort Studies

ASJC Scopus subject areas

  • Emergency Medicine

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Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. / the Pediatric Emergency Care Applied Research Network (PECARN).

In: Academic Emergency Medicine, Vol. 23, No. 8, 01.08.2016, p. 878-884.

Research output: Contribution to journalArticle

the Pediatric Emergency Care Applied Research Network (PECARN). / Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. In: Academic Emergency Medicine. 2016 ; Vol. 23, No. 8. pp. 878-884.
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title = "Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma",
abstract = "Objective: The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma. Methods: This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children <2 years old and the standard GCS for those ≥2 years old. Outcomes were TBI visible on CT and clinically important TBI (ciTBI), defined as death from TBI, neurosurgery, intubation for more than 24 hours for the head injury, or hospitalization for 2 or more nights for the head injury in association with TBI on CT. We compared the areas under the receiver operating characteristic (ROC) curves between age cohorts for the association of GCS and the TBI outcomes. Results: We enrolled 42,041 patients, of whom 10,499 (25.0{\%}) were <2 years old. Among patients <2 years, 313/3,329 (9.4{\%}, 95{\%} confidence interval [CI] = 8.4{\%} to 10.4{\%}) of those imaged had TBIs on CT and 146/10,499 (1.4{\%}, 95{\%} CI = 1.2{\%} to 1.6{\%}) had ciTBIs. In patients ≥2 years, 773/11,977 (6.5{\%}, 95{\%} CI = 6.0{\%} to 6.9{\%}) of those imaged had TBIs on CT and 572/31,542 (1.8{\%}, 95{\%} CI = 1.7{\%} to 2.0{\%}) had ciTBIs. For the pediatric GCS in children <2 years old, the area under the ROC curve was 0.61 (95{\%} CI = 0.59 to 0.64) for TBI on CT and 0.77 (95{\%} CI = 0.73 to 0.81) for ciTBI. For the standard GCS in older children, the area under the ROC curve was 0.71 (95{\%} CI = 0.70 to 0.73) for TBI on CT scan and 0.81 (95{\%} CI = 0.79 to 0.83) for ciTBI. Conclusions: The pediatric GCS for preverbal children was somewhat less accurate than the standard GCS for older children in identifying those with TBI on CT. However, the pediatric GCS for preverbal children and the standard GCS for older children were equally accurate for identifying ciTBI.",
author = "{the Pediatric Emergency Care Applied Research Network (PECARN)} and Borgialli, {Dominic A.} and Prashant Mahajan and Hoyle, {John D.} and Powell, {Elizabeth C.} and Nadel, {Frances M.} and Tunik, {Michael G.} and Adele Foerster and Lydia Dong and Michelle Miskin and Dayan, {Peter S.} and {Holmes Jr}, {James F} and Nathan Kuppermann and Jennifer Walthall and M. Gerardi and M. Tunik and J. Tsung and K. Melville and L. Lee and P. Mahajan and P. Dayan and F. Nadel and E. Powell and S. Atabaki and K. Brown and T. Glass and J. Hoyle and A. Cooper and E. Jacobs and A. Foerster and D. Monroe and D. Borgialli and M. Gorelick and S. Bandyopadhyay and M. Bachman and N. Schamban and J. Callahan and N. Kuppermann and J. Holmes and R. Lichenstein and R. Stanley and M. Badawy and L. Babcock-Cimpello and J. Schunk and K. Quayle and D. Jaffe and K. Lillis",
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T1 - Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma

AU - the Pediatric Emergency Care Applied Research Network (PECARN)

AU - Borgialli, Dominic A.

AU - Mahajan, Prashant

AU - Hoyle, John D.

AU - Powell, Elizabeth C.

AU - Nadel, Frances M.

AU - Tunik, Michael G.

AU - Foerster, Adele

AU - Dong, Lydia

AU - Miskin, Michelle

AU - Dayan, Peter S.

AU - Holmes Jr, James F

AU - Kuppermann, Nathan

AU - Walthall, Jennifer

AU - Gerardi, M.

AU - Tunik, M.

AU - Tsung, J.

AU - Melville, K.

AU - Lee, L.

AU - Mahajan, P.

AU - Dayan, P.

AU - Nadel, F.

AU - Powell, E.

AU - Atabaki, S.

AU - Brown, K.

AU - Glass, T.

AU - Hoyle, J.

AU - Cooper, A.

AU - Jacobs, E.

AU - Foerster, A.

AU - Monroe, D.

AU - Borgialli, D.

AU - Gorelick, M.

AU - Bandyopadhyay, S.

AU - Bachman, M.

AU - Schamban, N.

AU - Callahan, J.

AU - Kuppermann, N.

AU - Holmes, J.

AU - Lichenstein, R.

AU - Stanley, R.

AU - Badawy, M.

AU - Babcock-Cimpello, L.

AU - Schunk, J.

AU - Quayle, K.

AU - Jaffe, D.

AU - Lillis, K.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objective: The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma. Methods: This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children <2 years old and the standard GCS for those ≥2 years old. Outcomes were TBI visible on CT and clinically important TBI (ciTBI), defined as death from TBI, neurosurgery, intubation for more than 24 hours for the head injury, or hospitalization for 2 or more nights for the head injury in association with TBI on CT. We compared the areas under the receiver operating characteristic (ROC) curves between age cohorts for the association of GCS and the TBI outcomes. Results: We enrolled 42,041 patients, of whom 10,499 (25.0%) were <2 years old. Among patients <2 years, 313/3,329 (9.4%, 95% confidence interval [CI] = 8.4% to 10.4%) of those imaged had TBIs on CT and 146/10,499 (1.4%, 95% CI = 1.2% to 1.6%) had ciTBIs. In patients ≥2 years, 773/11,977 (6.5%, 95% CI = 6.0% to 6.9%) of those imaged had TBIs on CT and 572/31,542 (1.8%, 95% CI = 1.7% to 2.0%) had ciTBIs. For the pediatric GCS in children <2 years old, the area under the ROC curve was 0.61 (95% CI = 0.59 to 0.64) for TBI on CT and 0.77 (95% CI = 0.73 to 0.81) for ciTBI. For the standard GCS in older children, the area under the ROC curve was 0.71 (95% CI = 0.70 to 0.73) for TBI on CT scan and 0.81 (95% CI = 0.79 to 0.83) for ciTBI. Conclusions: The pediatric GCS for preverbal children was somewhat less accurate than the standard GCS for older children in identifying those with TBI on CT. However, the pediatric GCS for preverbal children and the standard GCS for older children were equally accurate for identifying ciTBI.

AB - Objective: The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma. Methods: This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children <2 years old and the standard GCS for those ≥2 years old. Outcomes were TBI visible on CT and clinically important TBI (ciTBI), defined as death from TBI, neurosurgery, intubation for more than 24 hours for the head injury, or hospitalization for 2 or more nights for the head injury in association with TBI on CT. We compared the areas under the receiver operating characteristic (ROC) curves between age cohorts for the association of GCS and the TBI outcomes. Results: We enrolled 42,041 patients, of whom 10,499 (25.0%) were <2 years old. Among patients <2 years, 313/3,329 (9.4%, 95% confidence interval [CI] = 8.4% to 10.4%) of those imaged had TBIs on CT and 146/10,499 (1.4%, 95% CI = 1.2% to 1.6%) had ciTBIs. In patients ≥2 years, 773/11,977 (6.5%, 95% CI = 6.0% to 6.9%) of those imaged had TBIs on CT and 572/31,542 (1.8%, 95% CI = 1.7% to 2.0%) had ciTBIs. For the pediatric GCS in children <2 years old, the area under the ROC curve was 0.61 (95% CI = 0.59 to 0.64) for TBI on CT and 0.77 (95% CI = 0.73 to 0.81) for ciTBI. For the standard GCS in older children, the area under the ROC curve was 0.71 (95% CI = 0.70 to 0.73) for TBI on CT scan and 0.81 (95% CI = 0.79 to 0.83) for ciTBI. Conclusions: The pediatric GCS for preverbal children was somewhat less accurate than the standard GCS for older children in identifying those with TBI on CT. However, the pediatric GCS for preverbal children and the standard GCS for older children were equally accurate for identifying ciTBI.

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