title: Does a prehospital Glasgow Coma Scale score predict pediatric outcomes?
abstract: BACKGROUND
  Although the Glasgow Coma Scale (GCS) score is widely used by medical professionals to evaluate and predict neurological outcomes, studies using the prehospital (P) GCS score to predict neurological outcomes in children are few.
  
  
  OBJECTIVE
  The objective of this study was to determine the agreement between the P GCS score and the emergency department (ED) GCS score, and the association between P GCS score and outcomes at hospital discharge in pediatric patients 5 to 18 years of age.
  
  
  METHODS
  Medical record review of children 5 to 18 years old with traumatic brain injury (TBI) was conducted. Children with documented P and ED GCS scores were eligible for enrollment. The hospital records of each enrolled child were reviewed, and the Glasgow outcome score and the disability rating scale scores were calculated. Agreement between the P and ED GCS scores was calculated using χ (κ statistic).
  
  
  RESULTS
  One hundred eighty-five subjects were included. There was strong agreement between P and ED GCS scores (κ = +0.69; confidence interval, 0.57-0.81). The Glasgow outcome score category improved with improving GCS category. The median disability rating scale score was also similar for P and ED GCS scores and was higher with decreasing GCS.
  
  
  CONCLUSIONS
  Our data showed strong agreement between P and ED GCS scores. Also, there was strong association between P GCS scores and short-term outcomes in children with TBI. The results support the use of GCS in prehospital transport destination guidelines for children with TBI.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA. jo-ann.nesiama@utsouthwestern.edu
authors.forename: Jo-Ann O
authors.initials: JA
authors.lastname: Nesiama
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Pirallo
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
authors.forename: Halim
authors.initials: H
authors.lastname: Hennes
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D012372:ROC Curve; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014922:Wisconsin / Q000453:epidemiology