Nuttall Amy Gl, Paton Katie M, Kemp Alison M
Division of Population Medicine, Cardiff University, Cardiff, UK.
BMJ Open. 2018 Nov 28;8(11):e023216. doi: 10.1136/bmjopen-2018-023216.
To evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury.
Cross sectional study.
UK hospital admissions: September 2009-February 2010.
<15 years with head injury.
GCS and/or AVPU at injury scene and in emergency departments (ED).
Measures used, the equivalence of AVPU to GCS, GCS at the scene predicting GCS in ED, CT results by age, hospital type.
Level of consciousness was recorded in 91% (5168/5700) in ED (43%: GCS/30.5%: GCS+AVPU/17.3%: AVPU) and 66.1% (1190/1801) prehospital (33%: GCS/26%GCS+AVPU/7%: AVPU). Failure to record level of consciousness and the use of AVPU were greatest for infants. Correlation between AVPU and median GCS in 1147 children <5 years: A=15, V=14, P=8, U=3, for 1163 children ≥5 years: A=15, V=13, P=11, U=3. There was no significant difference in the proportion of infants who had a CT whether AVPU=V/P/U or GCS<15. However diagnostic yield of intracranial injury or depressed fracture was significantly greater for V/P/U than GCS<15 :7/7: 100% (95% CI 64.6% to 100%) versus 5/17: 29.4% (95% CI 13.3% to 53.1%). For children >1 year significantly more had a CT scan when GCS<14 was recorded than 'V/P/U only' and the diagnostic yield was greater. Prehospital GCS and GCS in the ED were the same for 77.4% (705/911).
There was a clear correlation between Alert and GCS=15 and between Unresponsive and GCS=3 but a wider range of GCS scores for responsive to Pain or Voice that varied with age. AVPU was valuable at initial assessment of infants and did not adversely affect the proportion of infants who had head CT or the diagnostic yield.
评估格拉斯哥昏迷量表（GCS）和清醒、对声音反应、对疼痛反应、无反应（AVPU）量表在头部受伤儿童中的实用性和等效性。
横断面研究。
英国医院入院病例：2009年9月至2010年2月。
年龄<15岁的头部受伤患儿。
在受伤现场和急诊科使用GCS和/或AVPU。
所采用的测量方法、AVPU与GCS的等效性、现场GCS对急诊科GCS的预测、按年龄和医院类型划分的CT结果。
急诊科91%（5168/5700）记录了意识水平（43%：GCS/30.5%：GCS+AVPU/17.3%：AVPU），院前为66.1%（1190/1801）（33%：GCS/26%：GCS+AVPU/7%：AVPU）。婴儿未记录意识水平的情况以及AVPU的使用最为常见。1147名<5岁儿童中AVPU与GCS中位数的相关性：清醒=15，对声音反应=14，对疼痛反应=8，无反应=3；1163名≥5岁儿童中：清醒=15，对声音反应=13，对疼痛反应=11，无反应=3。无论AVPU为对声音反应/对疼痛反应/无反应还是GCS<15，进行CT检查的婴儿比例无显著差异。然而，对声音反应/对疼痛反应/无反应组颅内损伤或凹陷性骨折的诊断率显著高于GCS<15组：7/7：100%（95%CI 64.6%至100%）对5/17：29.4%（95%CI 13.3%至53.1%）。对于>1岁儿童，记录到GCS<14时进行CT扫描的人数显著多于仅采用对声音反应/对疼痛反应/无反应评估的情况，且诊断率更高。院前GCS与急诊科GCS相同的比例为77.4%（705/911）。
清醒与GCS=15、无反应与GCS=3之间存在明显相关性，但对疼痛或声音有反应时GCS评分范围更广，且随年龄变化。AVPU在婴儿初始评估中具有价值，且不会对进行头部CT检查的婴儿比例或诊断率产生不利影响。
