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Updated: Jul 19, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review
1Department of Neurology, Medical Spectrum Enschede, Hospital Enschede, Enschede, The Netherlands.
Insights
Children with a Glasgow Coma Scale (GCS) score of 13 after traumatic brain injury (TBI) exhibit moderate TBI characteristics. These children require similar management to those with GCS 9-12, not mild TBI.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Emergency Medicine
Background:
- Traumatic brain injury (TBI) in children is a significant public health concern.
- Accurate classification of TBI severity is crucial for appropriate management and outcomes.
- The Glasgow Coma Scale (GCS) is a primary tool for assessing TBI severity in pediatric patients.
Purpose of the Study:
- To compare the clinical presentation and management of children with TBI and an initial GCS score of 13 to those with GCS 14-15 (mild TBI) and GCS 9-12 (moderate TBI).
- To determine if children with GCS 13 should be classified as mild or moderate TBI.
- To advocate for appropriate clinical management based on TBI severity.
Main Methods:
- A systematic literature search was conducted on PubMed for pediatric TBI studies (0-18 years) published between 2000 and 2020.
- Studies were selected based on initial GCS scores: 13 versus 14-15 and 9-12.
- Exclusion criteria included reviews, meta-analyses, non-US/European populations, abusive head trauma, and severe TBI.
Main Results:
- Children with GCS 13 (5% of mild TBI cases) often sustained high-energy trauma and presented with prolonged unconsciousness and post-traumatic amnesia compared to GCS 15.
- Abnormalities on head CT scans (9-16%) and neurosurgical interventions (3-8%) were more frequent in GCS 13 patients.
- Admission rates (>90%), hospitalization duration (>4 days), and ICU care (28%) for GCS 13 were comparable to those with GCS 9-12, and significantly higher than GCS 15.
Conclusions:
- Children with an initial GCS score of 13 following TBI demonstrate clinical and management characteristics consistent with moderate TBI.
- It is recommended to classify children with GCS 13 as having moderate TBI.
- This reclassification supports the implementation of appropriate, more intensive management strategies for this patient group.
Objective:
The objective of this article was to compare children with traumatic brain injury (TBI) and Glasgow Coma Scale score (GCS) 13 with children presenting with GCS 14 and 15 and GCS 9 to 12.
Data Source:
We searched PubMed for clinical studies of children of 0 to 18 years of age with mild TBI (mTBI) and moderate TBI, published in English language in the period of 2000 to 2020.
Study Selection:
We selected studies sub-classifying children with GCS 13 in comparison with GCS 14 and 15 and 9 to 12. We excluded reviews, meta-analyses, non-U.S./European population studies, studies of abusive head trauma, and severe TBI.
Data Synthesis:
Most children (>85%) with an mTBI present at the emergency department with an initial GCS 15. A minority of only 5% present with GCS 13, 40% of which sustain a high-energy trauma. Compared with GCS 15, they present with a longer duration of unconsciousness and of post-traumatic amnesia. More often head computerized tomography scans show abnormalities (in 9-16%), leading to neurosurgical intervention in 3 to 8%. Also, higher rates of severe extracranial injury are reported. Admission is indicated in more than 90%, with a median length of hospitalization of more than 4 days and 28% requiring intensive care unit level care. These data are more consistent with children with GCS 9 to 12. In children with GCS 15, all these numbers are much lower.
Conclusion:
We advocate classifying children with GCS 13 as moderate TBI and treat them accordingly.
