Hageman Gerard, Nihom Jik
Department of Neurology, Medical Spectrum Enschede, Hospital Enschede, Enschede, The Netherlands.
Neuropediatrics. 2022 Apr;53(2):83-95. doi: 10.1055/s-0041-1740455. Epub 2021 Dec 8.
The objective of this article was to compare children with traumatic brain injury (TBI) and Glasgow Coma Scale score (GCS) 13 with children presenting with GCS 14 and 15 and GCS 9 to 12.
We searched PubMed for clinical studies of children of 0 to 18 years of age with mild TBI (mTBI) and moderate TBI, published in English language in the period of 2000 to 2020.
We selected studies sub-classifying children with GCS 13 in comparison with GCS 14 and 15 and 9 to 12. We excluded reviews, meta-analyses, non-U.S./European population studies, studies of abusive head trauma, and severe TBI.
Most children (>85%) with an mTBI present at the emergency department with an initial GCS 15. A minority of only 5% present with GCS 13, 40% of which sustain a high-energy trauma. Compared with GCS 15, they present with a longer duration of unconsciousness and of post-traumatic amnesia. More often head computerized tomography scans show abnormalities (in 9-16%), leading to neurosurgical intervention in 3 to 8%. Also, higher rates of severe extracranial injury are reported. Admission is indicated in more than 90%, with a median length of hospitalization of more than 4 days and 28% requiring intensive care unit level care. These data are more consistent with children with GCS 9 to 12. In children with GCS 15, all these numbers are much lower.
We advocate classifying children with GCS 13 as moderate TBI and treat them accordingly.
本文的目的是比较格拉斯哥昏迷量表（GCS）评分为13分的创伤性脑损伤（TBI）儿童与GCS评分为14分和15分以及9分至12分的儿童。
我们在PubMed上搜索了2000年至2020年期间以英文发表的关于0至18岁轻度TBI（mTBI）和中度TBI儿童的临床研究。
我们选择了将GCS评分为13分的儿童与GCS评分为14分和15分以及9分至12分的儿童进行亚分类的研究。我们排除了综述、荟萃分析、非美国/欧洲人群研究、虐待性头部创伤研究和重度TBI研究。
大多数mTBI儿童（>85%）在急诊科就诊时初始GCS评分为15分。只有5%的少数儿童GCS评分为13分，其中40%遭受高能创伤。与GCS评分为15分的儿童相比，他们的昏迷持续时间和创伤后遗忘期更长。头部计算机断层扫描更常显示异常（9% - 16%），导致3%至8%的儿童需要神经外科干预。此外，报告的严重颅外损伤发生率更高。超过90%的儿童需要住院，住院时间中位数超过4天，28%的儿童需要重症监护病房级别的护理。这些数据与GCS评分为9分至12分的儿童更为一致。在GCS评分为15分的儿童中，所有这些数字都要低得多。
我们主张将GCS评分为13分的儿童归类为中度TBI并相应地进行治疗。
