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Preschool children with head injury: comparing injury severity measures and clinical care
Insights
The Head Abbreviated Injury Scale (AIS) better reflects hospital care and injury severity in preschool children with head injuries than the Glasgow Coma Scale (GCS). Head AIS may complement GCS for guiding pediatric head injury care.
Area of Science:
- Pediatric Traumatology
- Neurotrauma Research
- Injury Severity Scoring
Background:
- Pediatric head injuries require accurate assessment tools for effective management.
- Existing scales like the Glasgow Coma Scale (GCS) are used, but their utility in representing hospital care for pediatric head injuries needs further evaluation.
- The Abbreviated Injury Scale (AIS) is another measure of injury severity.
Purpose of the Study:
- To compare child, hospital course, and discharge characteristics based on admitting unit, injury type, head AIS, and GCS in preschool children with head injuries.
- To evaluate the congruence between AIS and GCS categories in this population.
- To determine which scale, head AIS or GCS, better represents hospital care and injury severity.
Main Methods:
- Retrospective chart review of 183 preschool children with head injuries admitted to either a Pediatric Intensive Care Unit (PICU) or a general care unit across seven hospitals.
- Data collected included injury type, head AIS scores, GCS scores, treatments, procedures, and discharge disposition.
- Analysis focused on comparing characteristics by admitting unit, injury type, and injury severity scales, and assessing the concordance between AIS and GCS.
Main Results:
- Concordance between head AIS and GCS categories was low (28%).
- Children with isolated head injuries had shorter hospital stays, less severe injuries, and near-normal GCS scores, requiring fewer interventions.
- The Head AIS categories provided more homogeneous groupings and better reflected the hospital care provided compared to GCS.
- GCS was less helpful in representing hospital care, while Head AIS categories were better indicators of injury severity and care.
Conclusions:
- The Head AIS is a more effective indicator of injury severity and hospital care for preschool children with head injuries than the GCS.
- The GCS, while crucial for neurological status changes, has limitations in reflecting overall hospital management in this context.
- Integrating the Head AIS score with the GCS may enhance the guidance of care for pediatric head injuries.
Abstract:
The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head injuries only, 20% had other fractures, 5% had organ damage, and 7% had all three. Injury severity was measured by head AIS and GCS scores. Treatments and procedures included tubes/lines, blood/blood products, and medications. Children with head injuries only had fewer hospital days, less severe head injuries, and near normal GCS scores. They were less likely to have tubes/lines and medications. Children were discharged with medications (61%) and medical equipment (14%). Five children were discharged to long-term care facilities, and five were discharged to rehabilitation facilities. Concordance of head AIS and GCS categories occurred for only 50 (28%) children. Although the GCS is the gold standard for identifying changes in neurological status, it was not as helpful in representing hospital care. Head AIS injury categories clustered children in more homogeneous groups and better represented hospital care. Head AIS categories are better indicators of injury severity and care provided than GCS. Head injury AIS score may be an important addition to GCS for guiding care.
