Reliability of Glasgow Coma Score in pediatric trauma patients

Sandra R. DiBrito, Marcelo Cerullo, Seth D. Goldstein, Susan Ziegfeld, Fray Dylan Stewart, Isam Nasr

Research output: Contribution to journalArticle

Abstract

Background: Discordant assessments of Glasgow Coma Score (GCS) following trauma can result in inappropriate triage. This study sought to determine the reliability of prehospital GCS compared to emergency department (ED) GCS. Methods: We conducted a retrospective review of traumas from 01/2000 to 12/2015 at a Level-1 pediatric trauma center. We evaluated reliability between field and ED GCS using Pearson's correlation. We ascertained the difference between prehospital and ED GCS (delta-GCS). Associations between patient characteristics and delta-GCS were modeled using Poisson and linear regression, adjusting for demographic and clinical covariates. Results: We identified 5306 patients. Pearson's correlation for GCS measurements was 0.57 for ages 0-3, and 0.67-0.77 for other age groups. Mean delta-GCS was highest for age. <. 3. years (0.95, SD = 2.4). Poisson regression demonstrated that compared to children 0-3. years, higher age was associated with lower delta-GCS (RR 0.65 95% CI 0.56-0.74). Linear regression showed that in those with a delta-GCS, more severe injury (higher ISS, worse ED disposition) and older age were associated with a negative change, signifying decline in score. Conclusions: GCS is generally unreliable in pediatric trauma patients aged 0-3. years, particularly the verbal score component. This may impact accuracy of triage priority for pediatric trauma patients. Level of evidence: III, Prognostic.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Coma
Pediatrics
Wounds and Injuries
Hospital Emergency Service
Triage
Linear Models
Trauma Centers
Age Groups
Demography

Keywords

  • GCS
  • Pediatric trauma
  • Prehospital trauma care

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

DiBrito, S. R., Cerullo, M., Goldstein, S. D., Ziegfeld, S., Stewart, F. D., & Nasr, I. (Accepted/In press). Reliability of Glasgow Coma Score in pediatric trauma patients. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2017.12.027

Reliability of Glasgow Coma Score in pediatric trauma patients. / DiBrito, Sandra R.; Cerullo, Marcelo; Goldstein, Seth D.; Ziegfeld, Susan; Stewart, Fray Dylan; Nasr, Isam.

In: Journal of Pediatric Surgery, 01.01.2018.

Research output: Contribution to journalArticle

DiBrito, Sandra R. ; Cerullo, Marcelo ; Goldstein, Seth D. ; Ziegfeld, Susan ; Stewart, Fray Dylan ; Nasr, Isam. / Reliability of Glasgow Coma Score in pediatric trauma patients. In: Journal of Pediatric Surgery. 2018.
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