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Published on: September 21, 2017
A practical outcome scale for paediatric head injury
M Crouchman1, L Rossiter, T Colaco
1Paediatric Neurosciences, King's College Hospital, Denmark Hill, London SE5 9RS, UK. marion.crouchman@kcl.ac.uk
Insights
The King's Outcome Scale for Childhood Head Injury (KOSCHI) offers a sensitive measure for childhood traumatic brain injury (TBI) outcomes. This pediatric scale improves upon the adult Glasgow Outcome Scale (GOS), aiding therapy evaluation.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Rehabilitation Medicine
Background:
- Traumatic brain injury (TBI) is a leading cause of acquired disability in children.
- Evaluating acute and rehabilitative therapies for pediatric TBI is hindered by a lack of simple outcome descriptors.
- Existing outcome scales may lack the sensitivity to capture subtle differences in recovery among children.
Purpose of the Study:
- To develop and introduce the King's Outcome Scale for Childhood Head Injury (KOSCHI) as a specialized pediatric adaptation of the Glasgow Outcome Scale (GOS).
- To enhance the sensitivity of outcome assessment at the milder end of the disability spectrum in pediatric head injury.
- To provide a practical tool for clinicians to describe, rate, and evaluate recovery in children with head injuries.
Main Methods:
- Adaptation of the adult Glasgow Outcome Scale (GOS) into a pediatric-specific scale, the KOSCHI.
- Expansion of the original five-category GOS to include more nuanced distinctions, particularly for milder outcomes.
- Inclusion of specific categories for 'vegetative' state and splitting 'good recovery' into two categories to reflect developmental importance.
Main Results:
- The KOSCHI provides increased sensitivity at the milder end of the disability range compared to the GOS.
- The scale was found to be quick and easy to use by clinicians.
- Inter-rater reliability studies indicated that some training may be beneficial for consistent application of the scale.
Conclusions:
- The KOSCHI is a practical and sensitive scale for assessing outcomes in pediatric head injury.
- It enables clinicians to effectively describe the rate and extent of recovery in children post-TBI.
- The KOSCHI facilitates the evaluation of interventions and research in pediatric TBI rehabilitation.
Abstract:
Traumatic brain injury (TBI) is the commonest cause of acquired disability in childhood. A major obstacle to the evaluation of acute and rehabilitative therapies after TBI is the lack of simple descriptors of outcome. We developed the King's Outcome Scale for Childhood Head Injury (KOSCHI), as a specific paediatric adaptation of the original adult Glasgow Outcome Scale (GOS). The KOSCHI expands the five category GOS to provide increased sensitivity at the milder end of the disability range. The GOS category of "persistent vegetative state" was replaced by "vegetative". "Good recovery" was allocated two categories, in acknowledgement of the long term importance of relatively minor sequelae in a developing child. The scale was quick and easy to use. Inter-rater reliability studies show that even with such an apparently simple scale, some training may be required. The KOSCHI provides a practical scale for paediatric head injury which will enable clinicians to describe rate and extent of recovery, and evaluate the effects of service and research interventions.
