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

doi:10.1136/emermed-2018-208154

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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, Jeremy orcid.org/0000-0002-9503-0928 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 1472-0213
Keyword(s)	Science & Technology Life Sciences & Biomedicine Emergency Medicine paediatric emergency medicine paediatric injury paediatrics
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
Persistent URL	http://hdl.handle.net/10536/DRO/DU:30144770

Document type:	Journal Article
Collections:	Faculty of Health School of Medicine


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