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Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
The Association of Glasgow Coma Scale Score With Clinically Important Traumatic Brain Injuries in Children
M Austin Johnson1, Daniel K Nishijima, Nathan Kuppermann
1From the Department of Emergency Medicine, University of California Davis Health, Sacramento, CA.
Insights
Clinically important traumatic brain injuries (ciTBIs) in children with blunt head trauma show a linear decrease in prevalence with higher Glasgow Coma Scale (GCS) scores. Children with a GCS of 4 had the highest ciTBI and neurosurgical intervention rates.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Epidemiology
Background:
- Accurate assessment of pediatric head trauma is crucial for guiding diagnostic and treatment decisions.
- Understanding the incidence of clinically important traumatic brain injuries (ciTBIs) based on initial Glasgow Coma Scale (GCS) scores is essential for pediatric emergency care.
Purpose of the Study:
- To determine the prevalence of ciTBI and neurosurgical intervention across all GCS scores (3-15) in children with blunt head trauma.
- To establish the relationship between initial GCS scores and the likelihood of ciTBI and subsequent neurosurgical procedures.
Main Methods:
- Secondary analysis of prospectively collected observational data from the Pediatric Emergency Care Applied Research Network.
- Inclusion of pediatric patients (under 18 years) presenting with nontrivial blunt head injury and complete GCS scores.
- Analysis of 43,379 children to determine ciTBI and neurosurgical intervention rates stratified by GCS score.
Main Results:
- Overall, 1.8% of children experienced ciTBI, and 0.5% underwent neurosurgery.
- Children with a GCS score of 4 exhibited the highest incidence of ciTBI (95.5%) and neurosurgical intervention (72.2%).
- A nearly linear decrease in ciTBI prevalence was observed as GCS scores increased from 4 to 15, with GCS 14 showing an 8.0% ciTBI rate.
Conclusions:
- A strong, nearly linear correlation exists between initial GCS scores and ciTBI in pediatric blunt head trauma.
- The highest risk for ciTBI and neurosurgery is concentrated in children with the lowest GCS scores (specifically GCS 4).
- Even children with a GCS score of 14 have a significant prevalence of ciTBI, underscoring the need for careful evaluation.
Objective:
An accurate understanding of the incidence of clinically important traumatic brain injuries (ciTBIs) based on presenting Glasgow Coma Scale (GCS) scores in pediatric patients is required to formulate a pretest probability of disease to guide testing and treatment. Our objective was to determine the prevalence of ciTBI and neurosurgical intervention for each GCS score (range 3-15) in children presenting after blunt head trauma.
Methods:
This was a secondary analysis of prospectively collected observational data from 25 pediatric emergency departments in the Pediatric Emergency Care Applied Research Network. Patients younger than 18 years with nontrivial blunt head injury were included.
Results:
A total of 43,379 children with complete GCS scores were included in the analysis. Seven hundred sixty-three children had ciTBIs (1.8%) and 200 underwent neurosurgery (0.5%). Children with GCS scores of 4 had the highest incidence of ciTBI (21/22, 95.5%) and neurosurgical intervention (16/22, 72.2%). A nearly linear decrease in the prevalence of ciTBI from a GCS score of 4 to a score of 15 was observed (R = 0.92). Of 1341 children, 107 (8.0%) presenting with GCS scores of 14 were found to have ciTBIs and 17 (1.3%) underwent neurosurgical intervention.
Conclusions:
A nearly linear relationship exists between the initial GCS score and ciTBI in children with blunt head trauma. The highest prevalence of ciTBI and neurosurgical intervention occurred in children with GCS scores of 4. Children presenting with GCS scores of 14 had a nonnegligible prevalence of ciTBI. These findings are critical to providers caring for children with blunt head trauma to accurately formulate pretest probabilities of ciTBI.
