title: Glasgow Coma Scale and outcomes after structural traumatic head injury in early childhood.
abstract: OBJECTIVE
  To assess the association of the Glasgow Coma Scale (GCS) with radiological evidence of head injury (the Abbreviated Injury Scale for the head region, AIS-HR) in young children hospitalized with traumatic head injury (THI), and the predictive value of GCS and AIS-HR scores for long-term impairment.
  
  
  METHODS
  Our study involved a 10-year retrospective review of a database encompassing all patients admitted to Starship Children's Hospital (Auckland, New Zealand, 2000-2010) with THI.
  
  
  RESULTS
  We studied 619 children aged <5 years at the time of THI, with long-term outcome data available for 161 subjects. Both GCS and AIS-HR scores were predictive of length of intensive care unit and hospital stay (all p<0.001). GCS was correlated with AIS-HR (ρ=-0.46; p<0.001), although mild GCS scores (13-15) commonly under-estimated the severity of radiological injury: 42% of children with mild GCS scores had serious-critical THI (AIS-HR 3-5). Increasingly severe GCS or AIS-HR scores were both associated with a greater likelihood of long-term impairment (neurological disability, residual problems, and educational support). However, long-term impairment was also relatively common in children with mild GCS scores paired with structural THI more severe than a simple linear skull fracture.
  
  
  CONCLUSIONS
  Severe GCS scores will identify most cases of severe radiological injury in early childhood, and are good predictors of poor long-term outcome. However, young children admitted to hospital with structural THI and mild GCS scores have an appreciable risk of long-term disability, and also warrant long-term follow-up.
authors: Liggins Institute, University of Auckland, Auckland, New Zealand.
authors: Natasha L
authors: NL
authors: Heather
authors: José G B
authors: JG
authors: Derraik
authors: John
authors: J
authors: Beca
authors: Paul L
authors: PL
authors: Hofman
authors: Rangi
authors: R
authors: Dansey
authors: James
authors: J
authors: Hamill
authors: Wayne S
authors: WS
authors: Cutfield
mesh_terms: D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012189:Retrospective Studies