TY  - JOUR
PY  - 2020//
TI  - Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury
JO  - Emergency medicine journal
A1  - Kochar, Amit
A1  - Borland, Meredith L.
A1  - Phillips, Natalie
A1  - Dalton, Sarah
A1  - Cheek, John Alexander
A1  - Furyk, Jeremy
A1  - Neutze, Jocelyn
A1  - Lyttle, Mark D.
A1  - Hearps, Stephen
A1  - Dalziel, Stuart
A1  - Bressan, Silvia
A1  - Oakley, Ed
A1  - Babl, Franz E.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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. <br><br>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. <br><br>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). <br><br>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.<br><br>© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.<p />  <p>Language: en</p>
LA  - en
SN  - 1472-0205
UR  - http://dx.doi.org/10.1136/emermed-2018-208154
ID  - ref1
ER  -