title: Is the Glasgow Coma Scale Score in Children in the Emergency Department Lower During the Night?
abstract: The body clock may, through stimulation of melatonin secretion, influence the Glasgow Coma Scale (GCS) score. The aim of this study was to investigate whether the time of presentation of children in the emergency department is associated with GCS scores.
  
  
  METHODS
  We performed a retrospective review of 6,649 records of children presenting to an emergency department, with comparison of patients with GCS scores lower than 15 seen during the daytime and night time regarding diagnosis, disease severity, GCS score, age, sex, and ethnic group.
  
  
  RESULTS
  Of 4,034 children seen during the daytime, 25 had GCS scores lower than 15, whereas 34 of 2,592 children seen during the night had GCS scores lower than 15 (P = .005). There were no differences in age, sex, ethnicity, or disease severity between the group of patients seen during the daytime and those seen during the night. Conditions presenting with reduced GCS scores were seizures (32%), respiratory tract infection (17%), other infections (20%), trauma (13%), and other conditions (18%). Significantly more children with respiratory tract infections and low GCS scores presented during the night (P = .029).
  
  
  CONCLUSIONS
  The presentation of children with low GCS scores was more common during the night. Children with reduced GCS scores and viral respiratory tract infections presented more frequently during the night. Assessment of patients' level of consciousness during the night needs to discriminate difficulties in eliciting a response due to fatigue from features of cerebral dysfunction.
authors.affiliation: Luton, United Kingdom.
authors.forename: Ramona
authors.initials: R
authors.lastname: Onita
authors.affiliation: Luton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Kirby
authors.affiliation: Luton, United Kingdom. Electronic address: michael_eisenhut@yahoo.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Eisenhut
mesh_terms: D000367:Age Factors; D001683:Biological Clocks; D002648:Child; D002940:Circadian Rhythm; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D006113:United Kingdom
keywords: Circadian; Diurnal; Glasgow Coma Scale; Night; Nocturnal