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How Reliable is GCS in Pediatric Trauma?
Marcelo Cerullo MPH, Sandra R. DiBrito MD, Seth D. Goldstein MD PhD, Susan Ziegfeld PNP-BC, Dylan Stewart MD, Isam W. Nasr MD. Johns Hopkins School of Medicine, Department of Surgery, Division of Pediatric Surgery, Baltimore, MD, USA.

Background: Inaccurate or assessment of Glasgow Coma Score (GCS) following pediatric trauma can result in inappropriate triaging or misappropriation of resources. This study sought to determine how the reliability of GCS measurements taken in the field varied across age groups.

Methods: A retrospective review of pediatric trauma team activations from January 2000 to December 2015 at a Level 1 pediatric trauma center was conducted. Test/retest reliability between on-scene and emergency department (ED) GCS was ascertained using Pearson's correlation coefficient. Association between age and the difference between on-scene and ED GCS (delta-GCS) was modeled using Poisson regression, adjusting for demographic/clinical covariates including trauma and injury severity score (TRISS).

Results: We identified 7,841 patients; 18.4% <3 years of age, 16.0% 3-6 years, 16.6% 6-9 years, and 49.0% >9 years. Mean delta-GCS was highest for age <3 years (1.11, SD=2.27). Pearson's correlation for GCS measurements was 0.57 for ages 0-3, and 0.73-0.78 for other age groups. Poisson regression demonstrated that compared to children 0-3 years, higher age was associated with lower delta-GCS (3-6 years: incidence rate ratio IRR=0.866,p=0.005; 6-9 years: IRR=0.690, p<0.001; >9 years: IRR=0.686, p<0.001). Higher delta-GCS was associated with non-white race (IRR=1.13, p=0.001) and higher TRISS (IRR=4.03; p<0.001), while lower delta-GCS was associated with lack of insurance (IRR=0.877, p=0.003).

Conclusions: GCS taken in the field is significantly less reliable for younger children, those of non-white race, and higher TRISS. This has implications for trauma care systems that may determine triage priority on the basis of on-scene GCS.

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