Gcs-pupil Score Is A Better Predictor Of Mortality Than Gcs Alone In Severe Pediatric Traumatic Brain Injury.
Binod Balakrishnan, *Sheila J Hanson, Heather Trimmer, Raquel Farias-Moeller
Medical College of Wisconsin, Wauwatosa, WI
Glasgow Coma Scale score (GCS), used to classify the severity of traumatic brain injury (TBI), is associated with outcomes. However, GCS can be affected by sedation and neuromuscular blockade. GCS-Pupil score (GCS-P), calculated as GCS minus Pupil Reactivity Score (PRS), was shown to better predict outcomes in a retrospective cohort of adult TBI patients1. We evaluated the applicability of GCS-P to a large retrospective pediatric severe TBI (sTBI) cohort.
Admissions to pediatric intensive care units in the Virtual Pediatric Systems database from 2010-2015 with sTBI were included. We collected GCS, PRS, cardiac arrest, child abuse status, illness severity scores, pediatric cerebral performance category (PCPC) and mortality. Chi-square or Fisher's exact test and Mann Whitney U test compared categorical and continuous variables respectively. Multivariable classification regression trees analyzed predictors of mortality and PCPC at discharge.
Among the 2682 patients, mortality was 23%, increasing from 4.7% for PRS = 0 to 80% for PRS=2. GCS-P ≤ 2 had the strongest association with mortality, OR = 79.9 (95% CI = 60.3, 105.8). GCS ≤ 5 had the strongest association with unfavorable PCPC, OR = 9.1 (5.1, 16.1), and in this group, 1-2 unreactive pupils was associated unfavorable PCPC with OR = 8.4 (95% CI = 1.7, 13.8).
GCS-P, incorporating pupil reactivity to GCS scoring, improves the ability to predict mortality in children with sTBI.
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