Validation of the French translation of the Glasgow Outcome Scale–Extended, Pediatric version (GOS-E Peds): Clinical utility in assessing outcome in children and adolescents following acquired brain injury (ABI)

Abstract

The GOS-E Pediatric version allows measuring overall outcome in children and adolescents following ABI. Scores range from 1: upper good recovery, to 7: vegetative state. To validate the French translation of the GOS-E Peds in children with (ABI) of various severity and stages post-injury. The GOS-E Peds was used in a PMR department devoted to children with ABI, in three groups of patients: (1) patients shortly hospitalised post-ABI: GOS-E Peds was rated upon admission, at 3 and 6 months post-injury; (2) patients several years post-injury, requiring services of a multi-disciplinary outreach team; (3) patients followed-up on simple medical clinics. The type and severity of ABI were collected. 398 patients were included [2/3 boys; mean age at injury 6 years (SD = 4)]. In group 1 ( n = 124), mean (SD) GOS-E Peds scores were 5.9(.77) upon admission, 5.12(1.2) at 3 months ( n = 99) and 4.88(1.45) at 6 months ( n = 83); scores were significantly worse in case of hemiplegia (66%). GOS-E Peds improved over time (0–3 months P < 0.0001; 3–6 months, P = 0.001). Although age at injury was not correlated with initial rating of GOS-E Peds ( r = –.18), younger age at injury was correlated to worse GOS-E Peds scores at 3 and 6 months ( r = –.3 and–.44; P < 0.001). In group 2, 101 patients were cross-sectionally assessed by the outreach team in April 2014 [mean age 14.8 (SD = 4) years]. Mean GOS-E Peds was 3.95 (SD = 1.4). Factors influencing GOS-E Peds were presence of cerebellar signs, younger age at injury ( r = –.29; P = 0.003) and lower intellectual ability ( r = –.27; P = 0.008). In group 3, 173 patients consecutively seen in clinics were assessed [mean age 10.4 years (SD = 4.5)]. Mean GOS-E Peds score was 3.3 (SD = 1.5). Presence of hemiplegia and cerebellar signs were significantly related to GOS-E Peds scores. Duration of coma, presence of diffuse brain injury and epilepsy negatively influenced GOS-E Peds scores in the three groups. The GOS-E Peds has good sensitivity to change, and higher levels when children need a multi-disciplinary outreach team in the long-term, than when they require simple clinic follow-up. Young age at injury, diffuse brain injury, epilepsy, motor impairments, and intellectual ability all significantly influence overall outcome.