Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury

Kochar, Amit, Borland, Meredith L, Phillips, Natalie, Dalton, Sarah, Cheek, John Alexander, Furyk, Jeremy, Neutze, Jocelyn, Lyttle, Mark D, Hearps, Stephen, Dalziel, Stuart, Bressan, Silvia, Oakley, Ed and Babl, Franz E 2020, Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury, Emergency medicine journal, vol. 37, no. 3, pp. 127-134, doi: 10.1136/emermed-2018-208154.

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Title Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury
Author(s) Kochar, Amit
Borland, Meredith L
Phillips, Natalie
Dalton, Sarah
Cheek, John Alexander
Furyk, JeremyORCID iD for Furyk, Jeremy
Neutze, Jocelyn
Lyttle, Mark D
Hearps, Stephen
Dalziel, Stuart
Bressan, Silvia
Oakley, Ed
Babl, Franz E
Journal name Emergency medicine journal
Volume number 37
Issue number 3
Start page 127
End page 134
Total pages 8
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2020-03
ISSN 1472-0205
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Emergency Medicine
paediatric emergency medicine
paediatric injury
Summary Objective Head injury (HI) is a common presentation to emergency departments (EDs). The risk of clinically important traumatic brain injury (ciTBI) is low. We describe the relationship between Glasgow Coma Scale (GCS) scores at presentation and risk of ciTBI. Methods Planned secondary analysis of a prospective observational study of children<18 years who presented with HIs of any severity at 10 Australian/New Zealand centres. We reviewed all cases of ciTBI, with ORs (Odds Ratio) and their 95% CIs (Confidence Interval) calculated for risk of ciTBI based on GCS score. We used receiver operating characteristic (ROC) curves to determine the ability of total GCS score to discriminate ciTBI, mortality and need for neurosurgery. Results Of 20 137 evaluable patients with HI, 280 (1.3%) sustained a ciTBI. 82 (29.3%) patients underwent neurosurgery and 13 (4.6%) died. The odds of ciTBI increased steadily with falling GCS. Compared with GCS 15, odds of ciTBI was 17.5 (95% CI 12.4 to 24.6) times higher for GCS 14, and 484.5 (95% CI 289.8 to 809.7) times higher for GCS 3. The area under the ROC curve for the association between GCS and ciTBI was 0.79 (95% CI 0.77 to 0.82), for GCS and mortality 0.91 (95% CI 0.82 to 0.99) and for GCS and neurosurgery 0.88 (95% CI 0.83 to 0.92). Conclusions Outside clinical decision rules, decreasing levels of GCS are an important indicator for increasing risk of ciTBI, neurosurgery and death. The level of GCS should drive clinician decision-making in terms of urgency of neurosurgical consultation and possible transfer to a higher level of care.
Language eng
DOI 10.1136/emermed-2018-208154
Indigenous content off
Field of Research 1103 Clinical Sciences
1110 Nursing
1117 Public Health and Health Services
HERDC Research category C1 Refereed article in a scholarly journal
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Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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