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Is the Glasgow Coma Scale Score in Children in the Emergency Department Lower During the Night?
Ramona Onita1, David Kirby1, Michael Eisenhut1
1Luton, United Kingdom.
Insights
Children presenting to the emergency department with low Glasgow Coma Scale (GCS) scores were more common at night. This trend was particularly noted in children with respiratory tract infections, suggesting a potential circadian influence on neurological assessment.
Area of Science:
- Pediatric Emergency Medicine
- Neurological Assessment
- Circadian Rhythms
Background:
- The body's internal clock, influenced by melatonin secretion, may impact neurological assessment scores like the Glasgow Coma Scale (GCS).
- Understanding temporal patterns in emergency department presentations is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To investigate the association between the time of emergency department presentation and Glasgow Coma Scale (GCS) scores in children.
- To identify specific conditions or patient demographics that may be disproportionately represented during nighttime presentations with reduced GCS.
Main Methods:
- Retrospective review of 6,649 pediatric emergency department records.
- Comparison of patients with GCS scores < 15 presenting during daytime versus nighttime.
- Analysis included diagnosis, disease severity, GCS score, age, sex, and ethnicity.
Main Results:
- A significantly higher proportion of children with GCS scores < 15 presented during the night (34/2,592) compared to daytime (25/4,034) (P = .005).
- No significant differences were observed in age, sex, ethnicity, or disease severity between daytime and nighttime groups.
- Respiratory tract infections were significantly more common among children with low GCS scores presenting at night (P = .029).
Conclusions:
- Pediatric emergency department presentations with low GCS scores are more frequent during nighttime hours.
- Viral respiratory tract infections are a notable condition associated with nighttime presentations of reduced GCS in children.
- Clinical assessment of pediatric patients' consciousness at night requires careful consideration to differentiate fatigue from genuine neurological impairment.
Unlabelled:
The body clock may, through stimulation of melatonin secretion, influence the Glasgow Coma Scale (GCS) score. The aim of this study was to investigate whether the time of presentation of children in the emergency department is associated with GCS scores.
Methods:
We performed a retrospective review of 6,649 records of children presenting to an emergency department, with comparison of patients with GCS scores lower than 15 seen during the daytime and night time regarding diagnosis, disease severity, GCS score, age, sex, and ethnic group.
Results:
Of 4,034 children seen during the daytime, 25 had GCS scores lower than 15, whereas 34 of 2,592 children seen during the night had GCS scores lower than 15 (P = .005). There were no differences in age, sex, ethnicity, or disease severity between the group of patients seen during the daytime and those seen during the night. Conditions presenting with reduced GCS scores were seizures (32%), respiratory tract infection (17%), other infections (20%), trauma (13%), and other conditions (18%). Significantly more children with respiratory tract infections and low GCS scores presented during the night (P = .029).
Discussion:
The presentation of children with low GCS scores was more common during the night. Children with reduced GCS scores and viral respiratory tract infections presented more frequently during the night. Assessment of patients' level of consciousness during the night needs to discriminate difficulties in eliciting a response due to fatigue from features of cerebral dysfunction.
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