Related Experiment Video
Updated: Aug 16, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Performance of the pediatric glasgow coma scale in children with blunt head trauma
James F Holmes1, Michael J Palchak, Thomas MacFarlane
1Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA, USA. jfholmes@ucdavis.edu
Insights
The pediatric Glasgow Coma Scale (GCS) accurately assesses preverbal children with blunt head trauma. This modified GCS shows comparable effectiveness to the standard GCS in identifying traumatic brain injury (TBI) requiring intervention.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Assessment Tools
Background:
- The standard Glasgow Coma Scale (GCS) is widely used to assess neurological status in patients with head trauma.
- Assessing consciousness and neurological deficits in preverbal children presents unique challenges.
- A modified pediatric GCS has been developed to better evaluate young children.
Purpose of the Study:
- To compare the diagnostic accuracy of the pediatric GCS in preverbal children (≤2 years) with blunt head trauma.
- To compare the accuracy of the pediatric GCS with the standard GCS in older children (>2 years) with blunt head trauma.
- To evaluate the effectiveness of the pediatric GCS in identifying traumatic brain injury (TBI) requiring acute intervention.
Main Methods:
- Prospective enrollment of children (<18 years) with blunt head trauma.
- Stratification into two age cohorts: ≤2 years (pediatric GCS) and >2 years (standard GCS).
- Comparison of receiver operating characteristic (ROC) curves to assess the association between GCS scores and TBI outcomes (CT-diagnosed TBI or TBI needing intervention).
Main Results:
- The study included 2,043 children; 327 were ≤2 years.
- For TBI needing acute intervention, the area under the ROC curve for pediatric GCS was 0.97 (95% CI = 0.94 to 1.00), compared to 0.87 (95% CI = 0.83 to 0.92) for standard GCS.
- Pediatric GCS demonstrated high accuracy, particularly in identifying the need for acute intervention in young children.
Conclusions:
- The pediatric GCS demonstrates favorable accuracy compared to the standard GCS for evaluating children with blunt head trauma.
- The pediatric GCS is especially effective in assessing preverbal children for traumatic brain injury requiring acute intervention.
- This modified scale improves the neurological assessment of young children with head injuries.
Objectives:
To compare the accuracy of a pediatric Glasgow Coma Scale (GCS) score in preverbal children with blunt head trauma with the standard GCS score in older children.
Methods:
The authors prospectively enrolled children younger than 18 years with blunt head trauma. Patients were divided into cohorts of those 2 years and younger and those older than 2 years. The authors assigned a pediatric GCS score to the younger cohort and the standard GCS score to the older cohort. Outcomes were 1) traumatic brain injury (TBI) on computed tomography (CT) scan or 2) TBI in need of acute intervention. The authors created and compared receiver operating characteristic (ROC) curves between the age cohorts for the association of GCS scores and TBI.
Results:
The authors enrolled 2,043 children, and 327 were 2 years and younger. Among these 327, 15 (7.7%; 95% confidence interval [CI] = 4.4% to 12.4%) of 194 who underwent imaging with CT had TBI visible and nine (2.8%; 95% CI = 1.3% to 5.2%) had TBI needing acute intervention. In children older than 2 years, 83 (7.7%; 95% CI = 6.2% to 9.5%) of the 1,077 who underwent imaging with CT had TBI visible and 96 (5.6%; 95% CI = 4.6% to 6.8%) had TBI needing acute intervention. For the pediatric GCS in children 2 years and younger, the area under the ROC curve was 0.72 (95% CI = 0.56 to 0.87) for TBI on CT scan and 0.97 (95% CI = 0.94 to 1.00) for TBI needing acute intervention. For the standard GCS in older children, the area under the ROC curve was 0.82 (95% CI = 0.76 to 0.87) for TBI on CT scan and 0.87 (95% CI = 0.83 to 0.92) for TBI needing acute intervention.
Conclusions:
This pediatric GCS for children 2 years and younger compares favorably with the standard GCS in the evaluation of children with blunt head trauma. The pediatric GCS is particularly accurate in evaluating preverbal children with blunt head trauma with regard to the need for acute intervention.
![Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F58641.jpg&w=3840&q=50)
