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Published on: November 9, 2018
Comparing Prognostic Value of the Pediatric Glasgow Coma Scale and the Glasgow Coma Scale - Pupils Score in Pediatric
Akif Bulut1, Nurgül Tekin, Nurcan Özyazıcıoğlu
1Author Affiliations: Neurosurgery Clinic, Bursa City Hospital, Bursa, Turkey (Akif Bulut, PhD); Neonatal Intensive Care Unit, Health Sciences University Bursa High Specialisation Training and Research Hospital, Bursa, Turkey (Nurgül Tekin, MSc); Department of Child Health and Diseases Nursing, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey (Nurcan Özyazıcıoğlu, PhD); Neurosurgery, Health Sciences University Bursa High Specialisation Training and Research Hospital, Bursa, Turkey (Elif Başaran, MSc); Pediatric Intensive Care Unit, Bursa City Hospital, Bursa, Turkey (Arzu Oto, PhD).
Background:
The Glasgow Coma Scale has been a standard tool for assessing consciousness in trauma patients for five decades, but its utility is limited by the omission of brainstem reflexes such as pupillary response.
Objective:
This study aimed to compare the prognostic accuracy of the Pediatric Glasgow Coma Scale (pGCS) and the Pediatric Glasgow Coma Scale - Pupils Score (pGCS-P) in predicting mortality and functional outcomes among pediatric patients with traumatic brain injury (TBI).
Methods:
This single-center observational cohort study was conducted from May 2022 to May 2023 at Bursa Training and Research Hospital, Health Sciences University, Turkey. Pediatric patients (age <18 years) presenting with TBI were evaluated for level of consciousness and pupillary responses on admission. Both the pGCS and pGCS-P scores were calculated for each patient. For patients with anisocoria but preserved light reflexes in both pupils, scoring adjustments were made.
Results:
Of the 134 patients studied, 59.7% were male, and the mean (SD) age was 6.3 (5.4) years. In-hospital mortality was 12.7%, and 5.1% had unfavorable functional outcomes (UFOs) at discharge. Both the pGCS-P and pGCS demonstrated excellent ability to predict mortality (AUC, 0.97, 95% CI: 0.94-0.99 and 0.97, 95% CI: 0.94-0.96, respectively). There was no statistically significant difference in prognostic performance between the two scores using either binomial (p = .165) or nonparametric (p = .445) analyses (p >.05).
Conclusions:
In pediatric patients with TBI, the prognostic accuracy of the pGCS with pupil response (pGCS-P) was comparable to that of the pGCS alone for predicting mortality and UFOs. Incorporation of the pupil score did not significantly improve prognostic discrimination in this cohort.
