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Comparison of three measures of injury severity in children with traumatic brain injury
C S Gotschall1, P H Papero, H M Snyder
1Emergency Trauma Services, Children's National Medical Center, Washington, DC, USA.
Insights
The ASCOT probability of survival is the most sensitive indicator of head injury severity in children after traumatic brain injury. This index is associated with long-term neurological outcomes, proving useful for assessing therapies.
Area of Science:
- Pediatric neurology
- Neurotraumatology
- Child psychology
Background:
- Traumatic brain injury (TBI) in children presents significant long-term challenges.
- Accurate assessment of TBI severity is crucial for predicting outcomes and guiding treatment.
- Existing severity indices may not fully capture the complexity of pediatric TBI.
Purpose of the Study:
- To compare the effectiveness of three TBI severity indices in predicting long-term neurological outcomes in children.
- To identify the most sensitive index for assessing head injury severity in pediatric TBI.
- To evaluate the utility of severity indices beyond simple survival prediction.
Main Methods:
- Eighty-six children (aged 6-15 years) with traumatic brain injury were assessed 12-36 months post-injury.
- A comprehensive battery of tests evaluated behavioral, cognitive, communicative, social, motoric, and neurological functions.
- Linear regression models were used to compare the Glasgow Coma Scale (GCS), ASCOT probability of survival, and Anatomic Profile head injury component against neurological outcomes.
Main Results:
- The ASCOT probability of survival demonstrated significant correlations with outcomes across all five neurological domains assessed.
- The Glasgow Coma Scale (GCS) and Anatomic Profile head injury component were only associated with outcomes in one domain each.
- ASCOT probability of survival, incorporating GCS, blood pressure, respiratory rate, and multisystem injury, proved most sensitive to head injury severity.
Conclusions:
- The ASCOT probability of survival is a superior predictor of long-term neurological outcomes in pediatric traumatic brain injury compared to GCS and Anatomic Profile.
- This index offers valuable insights into outcomes beyond survival, aiding in the evaluation of medical and rehabilitative interventions.
- ASCOT probability of survival shows promise as a key tool for research and clinical practice in pediatric TBI.
Abstract:
Eighty-six traumatically brain-injured children aged 6 to 15 years who were consecutively admitted to a pediatric Level I trauma center were recruited for participation in the study. A comprehensive battery of behavioral, cognitive, communicative, social, motoric, and neurological tests was administered to the children from 12 to 36 months postinjury. The performance of three severity indices, the Glasgow Coma Scale (GCS), the ASCOT probability of survival, and the head injury component of the Anatomic Profile, was compared with respect to their association with long-term outcomes in five neurological domains, as assessed by linear regression models. The ASCOT probability of survival was correlated to test scores in all five domains. The GCS and the head injury component of the Anatomic Profile were each correlated to outcome in only one domain. The ASCOT probability of survival, which includes coded variables for the GCS, systolic blood pressure, and respiratory rates on admission, as well as a measure of multisystem anatomic injury, was the most sensitive indicator of head injury severity and was associated with outcomes beyond survival and death in this population. Probability of survival is a promising brain injury severity index that may be useful in efforts to assess new medical and rehabilitative therapies for children with traumatic brain injury.