Holmes James F, Palchak Michael J, MacFarlane Thomas, Kuppermann Nathan
Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA, USA.
Acad Emerg Med. 2005 Sep;12(9):814-9. doi: 10.1197/j.aem.2005.04.019.
To compare the accuracy of a pediatric Glasgow Coma Scale (GCS) score in preverbal children with blunt head trauma with the standard GCS score in older children.
The authors prospectively enrolled children younger than 18 years with blunt head trauma. Patients were divided into cohorts of those 2 years and younger and those older than 2 years. The authors assigned a pediatric GCS score to the younger cohort and the standard GCS score to the older cohort. Outcomes were 1) traumatic brain injury (TBI) on computed tomography (CT) scan or 2) TBI in need of acute intervention. The authors created and compared receiver operating characteristic (ROC) curves between the age cohorts for the association of GCS scores and TBI.
The authors enrolled 2,043 children, and 327 were 2 years and younger. Among these 327, 15 (7.7%; 95% confidence interval [CI] = 4.4% to 12.4%) of 194 who underwent imaging with CT had TBI visible and nine (2.8%; 95% CI = 1.3% to 5.2%) had TBI needing acute intervention. In children older than 2 years, 83 (7.7%; 95% CI = 6.2% to 9.5%) of the 1,077 who underwent imaging with CT had TBI visible and 96 (5.6%; 95% CI = 4.6% to 6.8%) had TBI needing acute intervention. For the pediatric GCS in children 2 years and younger, the area under the ROC curve was 0.72 (95% CI = 0.56 to 0.87) for TBI on CT scan and 0.97 (95% CI = 0.94 to 1.00) for TBI needing acute intervention. For the standard GCS in older children, the area under the ROC curve was 0.82 (95% CI = 0.76 to 0.87) for TBI on CT scan and 0.87 (95% CI = 0.83 to 0.92) for TBI needing acute intervention.
This pediatric GCS for children 2 years and younger compares favorably with the standard GCS in the evaluation of children with blunt head trauma. The pediatric GCS is particularly accurate in evaluating preverbal children with blunt head trauma with regard to the need for acute intervention.
比较钝性头部创伤的学前期儿童的儿科格拉斯哥昏迷量表（GCS）评分与大龄儿童的标准GCS评分的准确性。
作者前瞻性纳入了18岁以下钝性头部创伤儿童。患者被分为2岁及以下组和2岁以上组。作者为较小组分配儿科GCS评分，为较大组分配标准GCS评分。结局为：1）计算机断层扫描（CT）显示创伤性脑损伤（TBI）；或2）需要急性干预的TBI。作者绘制并比较了不同年龄组之间GCS评分与TBI相关性的受试者工作特征（ROC）曲线。
作者纳入了2043名儿童，其中327名2岁及以下。在这327名儿童中，194名接受CT成像的儿童中有15名（7.7%；95%置信区间[CI]=4.4%至12.4%）CT可见TBI，9名（2.8%；95%CI=1.3%至5.2%）有需要急性干预的TBI。在2岁以上儿童中，1077名接受CT成像的儿童中有83名（7.7%；95%CI=6.2%至9.5%）CT可见TBI，96名（5.6%；95%CI=4.6%至6.8%）有需要急性干预的TBI。对于2岁及以下儿童的儿科GCS，CT扫描显示TBI时ROC曲线下面积为0.72（95%CI=0.56至0.87），需要急性干预时为0.97（95%CI=0.94至1.00）。对于大龄儿童的标准GCS，CT扫描显示TBI时ROC曲线下面积为0.82（95%CI=0.76至0.87），需要急性干预时为0.87（95%CI=0.83至0.92）。
在评估钝性头部创伤儿童时，这种针对2岁及以下儿童的儿科GCS与标准GCS相比具有优势。在评估钝性头部创伤的学前期儿童是否需要急性干预方面，儿科GCS特别准确。
