Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center.
Pediatrics. 2024 Aug 1;154(2). doi: 10.1542/peds.2024-066168.
Consciousness assessment is an important component in the prehospital care of ill or injured children. Both the Glasgow Coma Scale (GCS) and the Alert, Verbal, Pain, Unresponsive (AVPU) scale are used for this purpose. We sought to identify cut points for the GCS to correspond to the AVPU scale for pediatric emergency medical services (EMS) encounters.
We conducted a retrospective cross-sectional analysis using the 2019-2022 National EMS Information System data set, including children (<18 years) with a GCS and AVPU score. We evaluated several approaches to develop cut points for the GCS within the AVPU scale and reported measures of performance.
Of 6 186 663 pediatric encounters, 4 311 598 with both GCS and AVPU documentation were included (median age was 10 years [interquartile range 3-15]; 50.9% boys). Lower AVPU scores correlated with life-sustaining procedures, including those for airway management, seizure, and cardiac arrest. Optimal GCS cut points obtained via a grid-based search were 14 to 15 for alert, 11 to 13 for verbal, 7 to 10 for pain, and 3 to 6 for unresponsive. Overall accuracy was 0.95, with kappa of 0.61. Intraclass F1 statistics were lower for verbal (0.37) and pain (0.50) categories compared with alert (0.98) and unresponsive (0.78).
We developed a cross-walking between the AVPU and GCS scales. Overall performance was high, though performance within the verbal and pain categories was lower. These findings can be useful to enhance clinician handovers and to aid in the development of EMS-based prediction models.
意识评估是危重病儿或受伤儿童院前护理的重要组成部分。格拉斯哥昏迷评分（GCS）和警觉-言语-疼痛-无反应（AVPU）量表均用于此目的。我们旨在确定 GCS 的切点，使其与儿科急诊医疗服务（EMS）遭遇的 AVPU 量表相对应。
我们使用 2019-2022 年国家 EMS 信息系统数据集进行了回顾性横断面分析，其中包括有 GCS 和 AVPU 评分的儿童（<18 岁）。我们评估了几种方法来确定 GCS 在 AVPU 量表内的切点，并报告了性能指标。
在 6186636 例儿科就诊中，纳入了 4311598 例有 GCS 和 AVPU 记录的患者（中位数年龄为 10 岁[四分位距 3-15]；50.9%为男孩）。较低的 AVPU 评分与维持生命的程序相关，包括气道管理、癫痫发作和心脏骤停。通过网格搜索获得的最佳 GCS 切点为警觉为 14-15，言语为 11-13，疼痛为 7-10，无反应为 3-6。总体准确率为 0.95，kappa 为 0.61。言语（0.37）和疼痛（0.50）类别与警觉（0.98）和无反应（0.78）类别相比，F1 统计的内部一致性较低。
我们开发了 AVPU 和 GCS 量表之间的交叉对照。整体表现良好，但言语和疼痛类别的表现较低。这些发现可用于增强临床医生的交接，并有助于开发基于 EMS 的预测模型。
