Glasgow motor scale alone is equivalent to Glasgow Coma Scale at identifying children at risk for serious traumatic brain injury

Acker, Shannon N.; Ross, John; Partrick, David A.; Nadlonek, Nicole A.; Bronsert, Michael; Bensard, Denis D.

doi:10.1097/ta.0000000000000300

Cited by 43 publications

(21 citation statements)

References 18 publications

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“…In adults with severe head injuries, the motor component of the GCS has been shown to be the component most strongly correlated with injury severity and outcomes . One small trauma registry study of 96 children up to 18 years old with moderate‐to‐severe head injuries demonstrated similar findings, as did two more recent retrospective reviews of seriously injured children . In a previous study of children with mostly minor head trauma, however, the verbal and eye components were somewhat more important than the motor component consistently, but this did not achieve statistical significance .…”

Section: Discussionmentioning

confidence: 90%

Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma

Borgialli

Mahajan

Hoyle

et al. 2016

Academic Emergency Medicine

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Objective: The objective was to compare the accuracy of the pediatric Glasgow Coma Scale (GCS) score in preverbal children to the standard GCS score in older children for identifying those with traumatic brain injuries (TBIs) after blunt head trauma.Methods: This was a planned secondary analysis of a large prospective observational multicenter cohort study of children with blunt head trauma. Clinical data were recorded onto case report forms before computed tomography (CT) results or clinical outcomes were known. The total and component GCS scores were assigned by the physician at initial emergency department evaluation. The pediatric GCS was used for children <2 years old and the standard GCS for those ≥2 years old. Outcomes were TBI visible on CT and clinically important TBI (ciTBI), defined as death from TBI, neurosurgery, intubation for more than 24 hours for the head injury, or hospitalization for 2 or more nights for the head injury in association with TBI on CT. We compared the areas under the receiver operating characteristic (ROC) curves between age cohorts for the association of GCS and the TBI outcomes.

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Section: Discussionmentioning

confidence: 90%

Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma

Borgialli

Mahajan

Hoyle

et al. 2016

Academic Emergency Medicine

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“…Assessment of the neurologic status (D) includes a careful evaluation of the patient’s level of consciousness using the Glasgow Coma Scale (GCS), the assessment of pupillary size and reaction, lateralizing signs and spinal cord injury level. The GCS, with its pediatric version for preverbal children (Supplementary online Appendix), is predictive of patient outcome, particularly the best motor response [ 12 ]. The total GCS and its eye, vocal and motor components, as well as pupillary size and reaction should be carefully documented in the clinical notes at each assessment in order to promptly identify any neurological deterioration or improvement.…”

Section: Recommendationsmentioning

confidence: 99%

Italian guidelines on the assessment and management of pediatric head injury in the emergency department

et al. 2018

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ObjectiveWe aim to formulate evidence-based recommendations to assist physicians decision-making in the assessment and management of children younger than 16 years presenting to the emergency department (ED) following a blunt head trauma with no suspicion of non-accidental injury.MethodsThese guidelines were commissioned by the Italian Society of Pediatric Emergency Medicine and include a systematic review and analysis of the literature published since 2005. Physicians with expertise and experience in the fields of pediatrics, pediatric emergency medicine, pediatric intensive care, neurosurgery and neuroradiology, as well as an experienced pediatric nurse and a parent representative were the components of the guidelines working group.Areas of direct interest included 1) initial assessment and stabilization in the ED, 2) diagnosis of clinically important traumatic brain injury in the ED, 3) management and disposition in the ED. The guidelines do not provide specific guidance on the identification and management of possible associated cervical spine injuries. Other exclusions are noted in the full text.ConclusionsRecommendations to guide physicians practice when assessing children presenting to the ED following blunt head trauma are reported in both summary and extensive format in the guideline document.

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“…We registered the same vital parameters for children. GCS is validated for use in children with the same standards as adults and used in this study [55]. We dichotomised SBP, HR and RR as normal or abnormal according to the Norwegian modified paediatric early warning score [56][57][58][59], and defined SI as abnormal if > 1.22 up to six years, > 1.0 between six and twelve years and > 0.9 above twelve years [60,61].…”

Section: Vital Parameters (Children)mentioning

confidence: 99%

Clinical guided computer tomography decisions are advocated in potentially severely injured trauma patients: a one-year audit in a level 1 trauma Centre with long pre-hospital times

Bågenholm

Dehli

Hermansen

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: The International Commission on Radiological Protection's (ICRP) justification principles state that an examination is justified if the potential benefit outweighs the risk for radiation harm. Computer tomography (CT) contributes 50% of the radiation dose from medical imaging, and in trauma patients, the use of standardized whole body CT (SWBCT) increases. Guidelines are lacking, and reviews conclude conflictingly regarding the benefit. We aimed to study the degree of adherence to ICRP's level three justification, the individual dose limitation principle, in our institution. Methods: This is a retrospective clinical audit. We included all 144 patients admitted with trauma team activation to our regional Level 1 trauma centre in 2015. Injuries were categorized according to the Abbreviated Injury Scale (AIS) codes. Time variables, vital parameters and interventions were registered. We categorized patients into trauma admission SWBCT, selective CT or no CT examination strategy groups. We used descriptive statistics and regression analysis of predictors for CT examination strategy. Results: The 144 patients (114 (79.2%) males) had a median age of 31 (range 0-91) years. 105 (72.9%) had at least one AIS ≥ 2 injury, 26 (18.1%) in more than two body regions. During trauma admission, at least one vital parameter was abnormal in 46 (32.4%) patients, and 73 (50.7%) underwent SWBCT, 43 (29.9%) selective CT and 28 (19.4%) no CT examination. No or only minor injuries were identified in 17 (23.3%) in the SWBCT group. Two (4.6%) in the selective group were examined with a complement CT, with no new injuries identified. A significantly (p < 0.001) lower proportion of children (61.5%) than adults (89.8%) underwent CT examination despite similar injury grades and use of interventions. In adjusted regression analysis, patients with a high-energy trauma mechanism had significantly (p = 0.028) increased odds (odds ratio = 4.390, 95% confidence interval 1.174-16.413) for undergoing a SWBCT.

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Glasgow motor scale alone is equivalent to Glasgow Coma Scale at identifying children at risk for serious traumatic brain injury

Abstract: Prognostic study, level III.

Cited by 43 publications

References 18 publications

Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma

Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma

Italian guidelines on the assessment and management of pediatric head injury in the emergency department

Clinical guided computer tomography decisions are advocated in potentially severely injured trauma patients: a one-year audit in a level 1 trauma Centre with long pre-hospital times

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