Related Experiment Video
Updated: May 18, 2026
SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients
Published on: February 6, 2021
Does a prehospital Glasgow Coma Scale score predict pediatric outcomes?
Jo-Ann O Nesiama1, Ronald G Pirallo, E Brooke Lerner
1Division of Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA. jo-ann.nesiama@utsouthwestern.edu
Insights
The prehospital Glasgow Coma Scale (GCS) score strongly agrees with the emergency department GCS score and predicts outcomes in pediatric traumatic brain injury (TBI) patients.
Area of Science:
- Pediatric neurology
- Traumatic brain injury research
- Emergency medicine assessment
Background:
- The Glasgow Coma Scale (GCS) is crucial for assessing neurological outcomes.
- Limited research exists on the predictive value of prehospital (P) GCS in pediatric traumatic brain injury (TBI).
Purpose of the Study:
- To assess agreement between prehospital (P) GCS and emergency department (ED) GCS scores.
- To evaluate the association between P GCS and hospital discharge outcomes in pediatric TBI patients (ages 5-18).
Main Methods:
- Retrospective review of medical records for pediatric TBI patients (ages 5-18).
- Inclusion criteria: documented P GCS and ED GCS scores.
- Analysis of Glasgow Outcome Scale and Disability Rating Scale scores; agreement calculated using Kappa statistic (κ).
Main Results:
- Strong agreement observed between P GCS and ED GCS scores (κ = +0.69).
- Improved GCS scores correlated with better Glasgow Outcome Scale categories.
- Similar median Disability Rating Scale scores for P GCS and ED GCS, with scores increasing as GCS decreased.
Conclusions:
- Prehospital GCS scores demonstrate strong agreement with ED GCS scores in pediatric TBI.
- P GCS scores are strongly associated with short-term neurological outcomes.
- Findings support utilizing P GCS for prehospital transport guidelines in pediatric TBI cases.
Background:
Although the Glasgow Coma Scale (GCS) score is widely used by medical professionals to evaluate and predict neurological outcomes, studies using the prehospital (P) GCS score to predict neurological outcomes in children are few.
Objective:
The objective of this study was to determine the agreement between the P GCS score and the emergency department (ED) GCS score, and the association between P GCS score and outcomes at hospital discharge in pediatric patients 5 to 18 years of age.
Methods:
Medical record review of children 5 to 18 years old with traumatic brain injury (TBI) was conducted. Children with documented P and ED GCS scores were eligible for enrollment. The hospital records of each enrolled child were reviewed, and the Glasgow outcome score and the disability rating scale scores were calculated. Agreement between the P and ED GCS scores was calculated using χ (κ statistic).
Results:
One hundred eighty-five subjects were included. There was strong agreement between P and ED GCS scores (κ = +0.69; confidence interval, 0.57-0.81). The Glasgow outcome score category improved with improving GCS category. The median disability rating scale score was also similar for P and ED GCS scores and was higher with decreasing GCS.
Conclusions:
Our data showed strong agreement between P and ED GCS scores. Also, there was strong association between P GCS scores and short-term outcomes in children with TBI. The results support the use of GCS in prehospital transport destination guidelines for children with TBI.
