Related Experiment Video
Updated: Jul 13, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Validation of a relative head injury severity scale for pediatric trauma
Sara Cuff1, Stephen DiRusso, Thomas Sullivan
1NY Medical College Department of Surgery, Valhalla, New York, USA.
Insights
A new Relative Head Injury Severity Scale (RHISS) effectively quantifies pediatric brain injury severity using ICD-9 codes. This scale is more accessible for trauma registries than the Glasgow Coma Score (GCS).
Area of Science:
- Pediatric Traumatology
- Neurological Injury Assessment
- Health Informatics
Background:
- Brain injury is a critical factor in pediatric trauma outcomes.
- The Glasgow Coma Score (GCS) has limitations in pediatric populations and trauma registries.
- A need exists for a reliable pediatric head injury severity metric compatible with administrative data.
Purpose of the Study:
- To validate a Relative Head Injury Severity Scale (RHISS) using ICD-9 codes for pediatric head injury assessment.
- To establish RHISS as a feasible and valid tool for statistical modeling of pediatric trauma outcomes.
- To compare the utility of RHISS with the Glasgow Coma Score (GCS) in trauma registries.
Main Methods:
- Utilized data from the National Pediatric Trauma Registry (NPTR) (1994-2001).
- Computed Survival Risk Ratios (SRRs) for head injury ICD-9 codes.
- Assigned ICD-9 codes to RHISS categories (0-3) and performed logistic regression analysis predicting mortality.
Main Results:
- GCS scores were missing for 96% of nonsurvivors.
- Mean SRRs differed significantly across RHISS categories (p < 0.001).
- RHISS was identified as an independent predictor of mortality (p < 0.01).
Conclusions:
- RHISS is a valid measure of head injury severity in pediatric trauma.
- RHISS is more readily available and computable from administrative data than GCS.
- RHISS offers a practical method for quantifying brain injury in pediatric trauma research.
Background:
Brain injury is the most important independent predictor of mortality and morbidity in pediatric trauma. The Glasgow Coma Score (GCS) is the commonly used clinical instrument to assess brain injury. However, the GCS or one of its components is often not applicable in children under a certain age or cannot be computed reliably because of the patient's condition or the circumstances surrounding resuscitation efforts. This limits its usefulness in statistical models of trauma outcomes, which rely on complete data collection and entry into trauma registries. This study provides evidence validating use of a relative head injury severity scale (RHISS) derived from available International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes to stratify degree of head injury.
Methods:
The patient population was derived from the National Pediatric Trauma Registry (NPTR;1994-2001). Survival Risk Ratios (SRRs) were computed for each head injury ICD-9 code. ICD-9 diagnosis codes related to head injury were then assigned to a RHISS category based on duration of loss of consciousness, location of skull fracture, or both: 0 = none; 1 = mild; 2 = moderate, or 3 = severe head injury. Analysis of variance compared mean SRRs across RHISS categories. Each patient was then assigned to a RHISS category based on their single worst ICD-9 head injury code. Logistic regression analysis was used to predict mortality based on New Injury Severity Score (NISS), whether the patient had been intubated, RHISS, and the Abbreviated Injury Score (AIS) for head and neck injuries.
Results:
GCS score was missing for 96% of nonsurvivors in the NPTR. Mean SRRs differed significantly (p < 0.001) among ICD-9 codes assigned to each RHISS category, as follows (Mean +/- SD): RHISS (0) = 0.93 +/- 0.16; RHISS (1) = 0.89 +/- 0.22; RHISS (2) = 0.85 +/- 0.26; RHISS (3) = 0.55 +/- 0.35. Logistic regression identified RHISS as an independent significant predictor (p < 0.01) of mortality.
Conclusion:
RHISS is a valid index of degree of head injury in the pediatric trauma population. Unlike GCS, RHISS is more likely to be available in trauma registries, and can be computed from administrative data. RHISS provides a feasible and valid method for quantifying the degree of brain injury in statistical models of pediatric trauma outcome.
