The motor response to stimulation predicts outcome as well as the full Glasgow Coma Scale in children with severe head injury.
OBJECTIVE
To evaluate how well the full Glasgow Coma Scale and the motor response, which is a subscore of the Glasgow Coma Scale, predict the outcome in children who have sustained a traumatic brain injury. The best scores in the first 24 hrs were used.


METHODS
A retrospective observational study.


METHODS
A pediatric intensive care unit.


METHODS
Children admitted between January 1997 and December 1999.


METHODS
None.


RESULTS
Recovery with independent function (good outcome), or death, persistent coma, or dependent (bad outcome) at 6 months after the injury. Complete information was available for 130 patients. Both the full Glasgow Coma Scale and the motor response predicted outcome well: the area under the receiver operating characteristic plot was 0.88 (95% confidence interval, 0.82-0.95) for the full score and 0.89 (0.82-0.95) for the motor response.


CONCLUSIONS
Both the full Glasgow Coma Scale score and the motor response provide a useful indication of long-term outcome, although neither score is sufficiently accurate to be used to limit treatment. The full Glasgow Coma Scale does not have a linear relationship with mortality, and there is poor interobserver agreement. The motor response should be used in children in preference to the full Glasgow Coma Scale; the predictive power is equivalent to the full Glasgow Coma Scale, there is a linear relationship to mortality, and it is easier to collect accurately.
Paediatric Care, Royal Manchester Children's Hospital, Manchester, UK. petermarc.fortune@manchester.ac.uk
Peter-Marc
PM
Fortune
Frank
F
Shann
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011597:Psychomotor Performance / Q000502:physiology*; D012189:Retrospective Studies