Prehospital Versus Trauma Center Glasgow Coma Scale in Pediatric Traumatic Brain Injury Patients

Area of Science:

• Pediatric emergency medicine
• Neurotrauma research
• Clinical assessment reproducibility

Background:

• Traumatic brain injury (TBI) is a significant cause of death and disability in children.
• The Glasgow Coma Scale (GCS) is a critical tool for assessing TBI severity but presents challenges in pediatric populations.
• Variability in GCS assessment can impact patient management and outcomes.

Purpose of the Study:

• To evaluate the reproducibility of the Glasgow Coma Scale (GCS) scores between prehospital providers and pediatric trauma center personnel.
• To identify factors influencing GCS score discrepancies in pediatric TBI patients.

Main Methods:

• Retrospective analysis of a level 1 pediatric trauma center's database.
• Inclusion of patients aged 18 years or younger with TBI.
• Comparison of prehospital GCS scores with in-hospital GCS scores using weighted kappa coefficients for agreement assessment.

Main Results:

• A total of 1711 pediatric TBI patients were analyzed; 263 were under 3 years old.
• Prehospital and trauma center GCS scores differed in 44.8% of patients.
• Moderate agreement (κ = 0.61) was observed overall, with lower agreement in children aged 0-2 years (κ = 0.51) compared to older children (κ = 0.63).
• Younger children (<3 years) were more likely to have a GCS score difference of at least 3 points.

Conclusions:

• There is frequent disagreement in GCS scores for pediatric TBI patients between prehospital and hospital settings.
• The inconsistency is particularly pronounced in children under 3 years and those with moderate TBI.
• Healthcare facilities should acknowledge the variability in pediatric GCS scoring during patient triage and management.