Early prediction of outcome following head injury in children: An assessment of the value of Glasgow Coma Scale score trend and abnormal plantar and pupillary light reflexes

Grewal, Manpreet S.; Sutcliffe, Anne J.

doi:10.1016/0022-3468(91)90323-l

Cited by 20 publications

(13 citation statements)

References 6 publications

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“…Finally, our results confirm that GCS represents the most accurate scoring system for evaluating the severity of head injury, although other studies have shown some limitations of GCS in predicting the outcome of traumatized children [30, 31]. The results of our study show that an initial low GCS score, multiple trauma, brain edema and coagulation abnormalities, including delayed aPTT, elevated FDP, low fibrinogen and decreased platelet count, represent important predictors of a poor outcome in children with head injury.…”

Section: Discussionsupporting

confidence: 75%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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Background: Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, their effect on clinical outcome remains unclear, particularly among children. Objectives: To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury. Study Design: We conducted a prospective observational study among 60 children with head injury, immediately evaluating severity of head injury (Glasgow Coma Scale, GCS); cerebral axial tomography; prothrombin time; activated partial thromboplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, we applied the Glasgow Outcome Score (GOS). Associations with GOS were evaluated using univariate and multivariate logistic models. Results: Among children with severe head injury, 22.2% (6/27) developed DIC, all of whom died and had shown severe brain edema. Among those with severe head injury yet without DIC, the mortality was only 14.2%. A low GOS was significantly and independently associated with a low GCS, multiple trauma, delayed aPTT, low fibrinogen level, elevated FDP and low platelet count. Brain edema was also associated with a low GOS, though not significantly. Conclusions: In addition to GCS, type of trauma, type of brain lesion and certain coagulation abnormalities are predictors of GOS.

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Section: Discussionsupporting

confidence: 75%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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“…This practice is problematic not only because there is inconsistency across studies with regard to which GCS score is used, but also in light of the fact that recent studies have reported that low GCS does not necessarily mean poor prognosis [34]. In fact, several studies have reported that secondary injury factors may be more important in predicting outcomes than the primary injury [27,33,34].…”

Section: Introductionmentioning

confidence: 97%

“…There are few studies available that specifically examine the utility of the GCS in assessing severity of injury in paediatric populations [27,33]. Furthermore, the majority of studies using severity of injury as a predictor of outcome use only one GCS score, including the best, the worst or the initial GCS, to determine injury severity.…”

Section: Introductionmentioning

confidence: 98%

Predicting social and functional outcomes for individuals sustaining paediatric traumatic brain injury

Wells

Minnes

Phillips³

2009

Developmental Neurorehabilitation

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“…Over the past 20 years, multiple studies have evaluated the ability of clinical variables and radiographic findings to predict outcome after traumatic brain injury (TBI). Earlier studies focused on clinical variables such as the Glasgow Coma Scale (GCS) score and pupillary reflexes to predict outcome [1,2,3,4,5], while more recent studies have focused on the use of radiologic variables, particularly magnetic resonance imaging, to predict outcome [6,7,8,9]. Similar studies in children with acute hypoxic ischemic encephalopathy (HIE) have demonstrated that specific abnormalities in pupil reactivity, somatosensory evoked potentials, electroencephalogram and magnetic resonance imaging predict poor outcome when performed at least 24 h, and ideally 48–72 h, after injury [10,11].…”

Section: Introductionmentioning

confidence: 99%

Trajectory Analysis of Serum Biomarker Concentrations Facilitates Outcome Prediction after Pediatric Traumatic and Hypoxemic Brain Injury

Berger

Bazaco

Wagner³

et al. 2010

Dev Neurosci

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Traumatic brain injury (TBI) and hypoxic ischemic encephalopathy (HIE) are leading causes of morbidity and mortality in children. Several studies over the past several years have evaluated the use of serum biomarkers to predict outcome after pediatric brain injury. These studies have all used simple point estimates such as initial and peak biomarker concentrations to predict outcome. However, this approach does not recognize patterns of change over time. Trajectory analysis is a type of analysis which can capture variance in biomarker concentrations over time and has been used with success in the social sciences. We used trajectory analysis to evaluate the ability of the serum concentrations of 3 brain-specific biomarkers – S100B, neuron-specific enolase (NSE) and myelin basic protein (MBP) – to predict poor outcome (Glasgow Outcome Scale scores 3–5) after pediatric TBI and HIE. Clinical and biomarker data from 100 children with TBI or HIE were evaluated. For each biomarker, we validated 2-, 3- and 4-group models for outcome prediction, using sensitivity and specificity. For S100B, the 3-group model predicted poor outcome with a sensitivity of 59% and specificity of 100%. For NSE, the 3-group model predicted poor outcome with a sensitivity of 48% and specificity of 98%. For MBP, the 3-group model predicted poor outcome with a sensitivity of 73% and specificity of 61%. Thus, when the models predicted a poor outcome, there was a very high probability of a poor outcome. In contrast, 17% of subjects with a poor outcome were predicted to have a good outcome by all 3 biomarker trajectories. These data suggest that trajectory analysis of biomarker data may provide a useful approach for predicting outcome after pediatric brain injury.

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Early prediction of outcome following head injury in children: An assessment of the value of Glasgow Coma Scale score trend and abnormal plantar and pupillary light reflexes

Cited by 20 publications

References 6 publications

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

Predicting social and functional outcomes for individuals sustaining paediatric traumatic brain injury

Trajectory Analysis of Serum Biomarker Concentrations Facilitates Outcome Prediction after Pediatric Traumatic and Hypoxemic Brain Injury

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