Development of a modified paediatric coma scale in intensive care clinical practice

Tatman, A.; Warren, Alison; Williams, Amanda; Powell, Judith E.; Whitehouse, William

doi:10.1136/adc.77.6.519

Cited by 81 publications

(41 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Scores were recorded for the modified pediatric GCS 32,46 (also referred to simply as "GCS" in discussions of pediatric patients) . All patients who presented with a GCS score of 3 or 4 were identified.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

Fulkerson

White

Rees

et al. 2015

PED

View full text Add to dashboard Cite

OBJECT Patients with traumatic brain injury (TBI) with low presenting Glasgow Coma Scale (GCS) scores have very high morbidity and mortality rates. Neurosurgeons may be faced with difficult decisions in managing the most severely injured (GCS scores of 3 or 4) patients. The situation may be considered hopeless, with little chance of a functional recovery. Long-term data are limited regarding the clinical outcome of children with severe head injury. The authors evaluate predictor variables and the clinical outcomes at discharge, 1 year, and long term (median 10.5 years) in a cohort of children with TBI presenting with postresuscitation GCS scores of 3 and 4. METHODS A review of a prospectively collected trauma database was performed. Patients treated at Riley Hospital for Children (Indianapolis, Indiana) from 1988 to 2004 were reviewed. All children with initial GCS (modified for pediatric patients) scores of 3 or 4 were identified. Patients with a GCS score of 3 were compared with those with a GCS score of 4. The outcomes of all patients at the time of death or discharge and at 1-year and long-term follow-up were measured with a modified Glasgow Outcome Scale (GOS) that included a “normal” outcome. Long-term outcomes were evaluated by contacting surviving patients. Statistical "classification trees" were formed for survival and outcome, based on predictor variables. RESULTS Sixty-seven patients with a GCS score of 3 or 4 were identified in a database of 1636 patients (4.1%). Three of the presenting factors differed between the GCS 3 patients (n = 44) and the GCS 4 patients (n = 23): presence of hypoxia, single seizure, and open basilar cisterns on CT scan. The clinical outcomes were statistically similar between the 2 groups. In total, 48 (71.6%) of 67 patients died, remained vegetative, or were severely disabled by 1 year. Eight patients (11.9%) were normal at 1 year. Ten of the 22 patients with long-term follow-up were either normal or had a GOS score of 5. Multiple clinical, historical, and radiological factors were analyzed for correlation with survival and clinical outcome. Classification trees were formed to stratify predictive factors. The pupillary response was the factor most predictive of both survival and outcome. Other factors that either positively or negatively correlated with survival included hypothermia, mechanism of injury (abuse), hypotension, major concurrent symptoms, and midline shift on CT scan. Other factors that either positively or negatively predicted long-term outcome included hypothermia, mechanism of injury, and the assessment of the fontanelle. CONCLUSIONS In this cohort of 67 TBI patients with a presenting GCS score of 3 or 4, 56.6% died within 1 year. However, approximately 15% of patients had a good outcome at 10 or more years. Factors that correlated with survival and outcome included the pupillary response, hypothermia, and mechanism. The authors discuss factors that may help surgeons make critical decisions regarding their most serious pediatric trauma patients.

show abstract

Section: Methodsmentioning

confidence: 99%

“…47 There are modifications of the adult GCS for children. 27,42,46 Adult patients with a GCS score of ≤ 8 are considered to have "severe" TBI. In children, a GCS score of 5 may be the critical level for "severe" TBI.…”

mentioning

confidence: 99%

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

Fulkerson

White

Rees

et al. 2015

PED

View full text Add to dashboard Cite

show abstract

“…8 For preverbal infants, a paediatric adaptation of the GCS was used that has good inter-and intraobserver reliability. 9 To provide an additional measure of injury severity, participants underwent testing for post-traumatic amnesia (PTA) using the Westmead PTA scale. 10 PTA testing was performed on the day of admission but was not continued if the patient scored full marks.…”

Section: Methodsmentioning

confidence: 99%

The King's Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury

Calvert

Miller

Curran

et al. 2008

Develop Med Child Neuro

View full text Add to dashboard Cite

The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post‐traumatic brain injury (TBI). We used a prospective cohort study. Eighty‐one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The male:female ratio was 1.8:1. The mean age was 11 years 10 months (SD 3.6, range 5–16y). Discharge KOSCHI categories were good (n=34), moderate (n=39), severe (n=6), and unclassifiable (n=2). KOSCHI category correlated strongly with admission Glasgow Coma Score, length of hospital stay, and post‐traumatic amnesia. It also correlated significantly with Verbal IQ and Performance IQ (Wechsler); measures of attention; health status (Health Utilities Index [HUI]); health‐related quality of life (Pediatric Quality of Life Inventory [PedsQL]); depressive symptoms (Birleson Depression Scale) assessed within 3 months postTBI; and with Verbal IQ, selective attention (map mission), and HUI and PedsQL domains assessed at least 6 months post‐TBI discharge. KOSCHI did not correlate with behaviour or executive function. We conclude that the KOSCHI scored at hospital discharge correlates with severity of injury and some cognitive, health status, and HRQL outcomes early after TBI. It is not helpful at predicting later difficulties, or behavioural and emotional problems.

show abstract

“…The GCS (Teasdale and Jennett 1974), considered the international standard for determining conscious levels, should be recorded at the time of injury to determine the severity of injury with ongoing assessments to identify and record changes in the child's condition. A modified GCS should be used when assessing children, as outlined in Figure 1 (NICE 2007;Tatman et al 1997). Nurses not experienced in using the GCS should undertake a rapid neurological assessment using the Alert (A), Verbal (V), Painful (P), Unresponsiveness (U) (AVPU) scale (Gaichas et al 2006).…”

Section: Assessment and Early Managementmentioning

confidence: 99%

Traumatic brain injury in children part 1—initial assessment and management

Braine

Smith

2013

British Journal of School Nursing

View full text Add to dashboard Cite

Traumatic Brain Injury (TBI) as a result of road traffic accident or falls is the leading causes of death or disability in children. Children and young people frequency access health services as a result of a TBI. Consequently many nurses working with children and young people, in both primary and secondary care settings will care for a child following a TBI and have a role to play in accident prevention. Understanding the initial stabilisation of a child who has sustained a TBI, and the principles of pre-hospital management are essential to ensure optimal care of the child and family. This article provides an overview of TBI and its management in children and the key role of primary care practitioners in relation to the identification of TBI and accident prevention.

show abstract

Development of a modified paediatric coma scale in intensive care clinical practice

Cited by 81 publications

References 16 publications

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4

The King's Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury

Traumatic brain injury in children part 1—initial assessment and management

Contact Info

Product

Resources

About