Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury.
OBJECTIVE
To study the hypothesis that, in the absence of an ischemic-hypoxic state, children with severe traumatic brain injury and with unfavorable Glasgow Coma Scale scores may have good recovery.


METHODS
Retrospective, observational, cross-sectional study with factorial design.


METHODS
Inpatient population in a university hospital.


METHODS
Seventy-nine children with traumatic brain injury admitted to the intensive care unit.


METHODS
All patients received close monitoring and strict control of intracranial pressure (less than 20 mm Hg) and cerebral perfusion pressure (greater than 60 mm Hg).


RESULTS
Admission Glasgow Coma Scale score, survival, need for cardiopulmonary resuscitation, presence of shock, peak intracranial pressure, duration of coma, Glasgow Outcome Scale score, and the results of neuropsychologic tests were analyzed. Of 79 children, 70 (89%) survived. Although the mortality rate was higher among patients with Glasgow Coma Scale scores of 3 to 5, 14 (64%) of 22 of these children survived. Nonsurvivors had a significantly higher incidence of shock and need for cardiopulmonary resuscitation. Except for two patients who had prolonged hypoxemia, all children, including those with Glasgow Coma Scale scores of 3 to 5, had a satisfactory outcome (Glasgow Outcome Scale scores of 4 or 5). Neuropsychologic outcome was not significantly different in the survivors with Glasgow Coma Scale scores of 3 to 5 and those with Glasgow Coma Scale scores of 6 or more.


CONCLUSIONS
A low Glasgow Coma Scale score does not always accurately predict the outcome of severe traumatic brain injury; in the absence of hypoxic-ischemic injury, children with traumatic brain injury and Glasgow Coma Scale scores of 3 to 5 can recover independent function.
Lieh-Lai
M W
MW
Division of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit 48201.
Theodorou
A A
AA
Sarnaik
A P
AP
Meert
K L
KL
Moylan
P M
PM
Canady
A I
AI
D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007427:Intracranial Pressure; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed