Citation

Heather NL, Derraik JG, Beca J, Hofman PL, Dansey R, Hamill J, Cutfield WS. PLoS One 2013; 8(12): e82245.

Affiliation

Liggins Institute, University of Auckland, Auckland, New Zealand.

Copyright

(Copyright © 2013, Public Library of Science)

DOI

10.1371/journal.pone.0082245

PMID

24312648

PMCID

PMC3846816

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. CONCLUSION: 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.

Language: en