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Published on: November 9, 2018
[Use of the Glasgow Coma Scale in pediatric craniocerebral trauma]
R D Stenger1, S Schmidt, B Beyer
1Klinik und Poliklinik für Kindermedizin, Ernst-Moritz-Arndt-Universität Greifswald.
Insights
The modified Glasgow Coma Scale effectively assesses pediatric head injury severity. Lower scores indicate poorer outcomes, while higher scores predict faster recovery in children.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Clinical assessment tools
Context:
- Head injuries are a significant cause of morbidity and mortality in children.
- Accurate and timely assessment of neurological status is crucial for effective management.
- The Glasgow Coma Scale (GCS) is a widely used tool, but its applicability in pediatric populations requires evaluation.
Purpose:
- To analyze the applicability of a modified Glasgow Coma Scale in pediatric patients with head and associated injuries.
- To correlate GCS scores with patient outcomes, including mortality, ventilation duration, and intensive care unit (ICU) length of stay.
- To evaluate the diagnostic and therapeutic utility of the GCS in pediatric neurotrauma.
Summary:
- A modified Glasgow Coma Scale was applied to 38 pediatric patients (mean age 7.2 years) with head injuries over five years.
- Patients were stratified into GCS score groups (4-8, 9-12, 13-19). Lower scores (4-8) were associated with 50% mortality, prolonged ventilation (11.7 days), and intensive care (45.7 days).
- Higher GCS scores (9-19) correlated with reduced ventilation and ICU stays, indicating better prognoses and quicker recovery.
Impact:
- The modified Glasgow Coma Scale provides a quantitative method for assessing pediatric head injury severity.
- It aids in guiding diagnostic and therapeutic interventions, even for inexperienced physicians at the accident site.
- This tool can improve patient management and outcomes in pediatric neurotrauma cases.
Abstract:
Over five years the applicability of a modified Glasgow Coma Scale was analysed in 38 children (mean age 7.2 +/- 3.8 years) with head and associated injuries (47.4%). The score was estimated after the accident and in the course of intensive therapy. At the beginning of the treatment on the intensive care unit, the cases were staged according to the severity of the head injuries (Glasgow Coma Scale: 4-8, 9-12 and 13-19 points). At the stage evaluated as between 4 and 8 points, 50% of the patients died and the survivors were ventilated (11.7 +/- 10.7 days) and intensively treated (45.7 +/- 31.5 days). All patients had had neurological damage. Additional injuries worsened the prognosis in the acute phase. 42.9% of the patients received intracranial pressure monitoring. In the patients between 9 and 12 points, the time of ventilation (3.7 +/- 2.9 days) and of intensive therapy (19.5 +/- 13.3 days) decreased. Over 13 points, all patients had a shorter duration of treatment (10.8 +/- 8.8 days) and a quick and good recovery. The Glasgow Coma Scale has the advantage of an examination with a quantitative analysis and resulting effective diagnostic and therapeutic measures. Even the inexperienced physician can use the Glasgow Coma Scale with success at the site of the accident.
