PT  - JOURNAL ARTICLE
AU  - Amit Kochar
AU  - Meredith L Borland
AU  - Natalie Phillips
AU  - Sarah Dalton
AU  - John Alexander Cheek
AU  - Jeremy Furyk
AU  - Jocelyn Neutze
AU  - Mark D Lyttle
AU  - Stephen Hearps
AU  - Stuart Dalziel
AU  - Silvia Bressan
AU  - Ed Oakley
AU  - Franz E Babl
TI  - Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury
AID  - 10.1136/emermed-2018-208154
DP  - 2020 Mar 01
TA  - Emergency Medicine Journal
PG  - 127--134
VI  - 37
IP  - 3
4099  - http://emj.bmj.com/content/37/3/127.short
4100  - http://emj.bmj.com/content/37/3/127.full
SO  - Emerg Med J2020 Mar 01; 37
AB  - Objective Head injury (HI) is a common presentation to emergency departments (EDs). The risk of clinically important traumatic brain injury (ciTBI) is low. We describe the relationship between Glasgow Coma Scale (GCS) scores at presentation and risk of ciTBI.Methods Planned secondary analysis of a prospective observational study of children<18 years who presented with HIs of any severity at 10 Australian/New Zealand centres. We reviewed all cases of ciTBI, with ORs (Odds Ratio) and their 95% CIs (Confidence Interval) calculated for risk of ciTBI based on GCS score. We used receiver operating characteristic (ROC) curves to determine the ability of total GCS score to discriminate ciTBI, mortality and need for neurosurgery.Results Of 20 137 evaluable patients with HI, 280 (1.3%) sustained a ciTBI. 82 (29.3%) patients underwent neurosurgery and 13 (4.6%) died. The odds of ciTBI increased steadily with falling GCS. Compared with GCS 15, odds of ciTBI was 17.5 (95% CI 12.4 to 24.6) times higher for GCS 14, and 484.5 (95% CI 289.8 to 809.7) times higher for GCS 3. The area under the ROC curve for the association between GCS and ciTBI was 0.79 (95% CI 0.77 to 0.82), for GCS and mortality 0.91 (95% CI 0.82 to 0.99) and for GCS and neurosurgery 0.88 (95% CI 0.83 to 0.92).Conclusions Outside clinical decision rules, decreasing levels of GCS are an important indicator for increasing risk of ciTBI, neurosurgery and death. The level of GCS should drive clinician decision-making in terms of urgency of neurosurgical consultation and possible transfer to a higher level of care.