Abstract
ObjectiveTo assess the association of the Glasgow Coma Scale (GCS) with radiological evidence of head injury (the Abbreviated Injury Scale for the head region, AIS-HR) in young children hospitalized with traumatic head injury (THI), and the predictive value of GCS and AIS-HR scores for long-term impairment.MethodsOur study involved a 10-year retrospective review of a database encompassing all patients admitted to Starship Children’s Hospital (Auckland, New Zealand, 2000–2010) with THI. ResultsWe studied 619 children aged <5 years at the time of THI, with long-term outcome data available for 161 subjects. Both GCS and AIS-HR scores were predictive of length of intensive care unit and hospital stay (all p<0.001). GCS was correlated with AIS-HR (ρ=-0.46; p<0.001), although mild GCS scores (13–15) commonly under-estimated the severity of radiological injury: 42% of children with mild GCS scores had serious–critical THI (AIS-HR 3–5). Increasingly severe GCS or AIS-HR scores were both associated with a greater likelihood of long-term impairment (neurological disability, residual problems, and educational support). However, long-term impairment was also relatively common in children with mild GCS scores paired with structural THI more severe than a simple linear skull fracture. ConclusionSevere GCS scores will identify most cases of severe radiological injury in early childhood, and are good predictors of poor long-term outcome. However, young children admitted to hospital with structural THI and mild GCS scores have an appreciable risk of long-term disability, and also warrant long-term follow-up.
Highlights
Traumatic head injury (THI, defined here as injury to the scalp, skull or brain) is a very common childhood event [1], and brain injuries are the most frequent cause of trauma fatality during childhood [2]
725 children with traumatic head injury (THI) who were less than five years of age were admitted to Starship Children’s Hospital over the 10-year study period (Figure 1). 38 children died (5%) during the admission, and another 29 cases were excluded (24 due to incomplete data and 5 whose primary injury was extracranial) (Figure 1)
Within our cohort of children admitted to hospital with THI, severe Glasgow Coma Scale (GCS) was a good predictor of severe radiological injury, mild GCS scores were less predictive of mild radiological injury (Figure 2)
Summary
Traumatic head injury (THI, defined here as injury to the scalp, skull or brain) is a very common childhood event [1], and brain injuries are the most frequent cause of trauma fatality during childhood [2]. The GCS is designed for an adult level of cognition, but modified versions are typically used to assess young children Given their inherent limitations, it is not surprising that GCS scores show a weak and inconsistent association with survival, functional outcome, and radiological severity scores within adult THI populations [9,10,11,12,13]. There is a weak relationship between injury severity according to initial GCS score and long-term cognitive and behavioural outcomes following early childhood THI [19,20]. We examined the association between post-resuscitation GCS, AIS-HR, and short-term markers of injury severity (including length of intensive care unit and hospital admission) after early childhood THI. We assessed the association between GCS and AIS-HR scores with disability in patients with follow-up data
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
