Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/126179
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Type: Journal article
Title: Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury
Author: Kochar, A.
Borland, M.L.
Phillips, N.
Dalton, S.
Cheek, J.A.
Furyk, J.
Neutze, J.
Lyttle, M.D.
Hearps, S.
Dalziel, S.
Bressan, S.
Oakley, E.
Babl, F.E.
Citation: Emergency Medicine Journal, 2020; 37(3):127-134
Publisher: BMJ
Issue Date: 2020
ISSN: 1472-0205
1472-0213
Statement of
Responsibility: 
Amit Kochar, Meredith L Borland, Natalie Phillips, Sarah Dalton, John Alexander Cheek, Jeremy Furyk ... et al.
Abstract: 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.
Keywords: paediatric emergency medicine
paediatric injury
paediatrics
Rights: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
DOI: 10.1136/emermed-2018-208154
Grant ID: http://purl.org/au-research/grants/nhmrc/1046727
http://purl.org/au-research/grants/nhmrc/1058560
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