S. DiBrito1,2, M. Cerullo1,2, S. Goldstein1, L. Martin1, M. Ladd1, S. Ziegfeld1, D. Stewart1, I. Nasr1 1Johns Hopkins University School Of Medicine,Pediatric Surgery,Baltimore, MD, USA 2Johns Hopkins School Of Public Health,Baltimore, MD, USA
Introduction: Inaccurate prehospital assessment of Glasgow Coma Score (GCS) following pediatric trauma can result in inappropriate triage and misappropriation of resources. This study sought to characterize differences in GCS measurements taken in the field versus those taken in the emergency department (ED).
Methods: Pediatric trauma team activations from January 2000 to December 2015 at a Level 1 pediatric trauma center were reviewed. For each patient the difference between reported on-scene and ED GCS (delta-GCS) was ascertained. Associations between patient characteristics and the presence of a nonzero delta-GCS was modeled using multivariable logistic regression, adjusting for demographic/clinical covariates including race, insurance status, transport time, and revised trauma score (RTS).
Results: We identified 5,551 patients and a 19% rate of nonzero delta-GCS. 14.4% (n=799) patients had an ED GCS greater than on-scene GCS, while only 4.3% (n=237) had an ED GCS that was lower than on-scene GCS. An improved ED GCS was most common among ages 0-3 years (24.5%, n=238), compared to ages 3-6 years (17.4%, n=154), ages 6-9 years (10.0%, n=92), and ages >9 years (11.4%, n=315) (Figure). On multivariable analysis, improved ED GCS was associated with younger age (<3 years) (odds ratio [OR]=2.47, 95% confidence interval [CI]=2.07-2.96), transport by helicopter (OR=1.32, 95%CI: 1.11-1.57), and admission to a higher level care unit (OR=1.61, 95%CI: 1.25-2.07), and an extended transport time (OR=1.58, 95%CI=1.01-2.47).
Conclusion: GCS taken in the field is commonly discrepant with that taken in the ED, most often lower in the field. Moreover, after adjusting for injury severity and transport time, younger age shows a clear association with higher ED GCS compared to on-scene GCS. Further study is needed to determine whether this trend represents improvement in clinical status during transport, or an opportunity to improve prehospital assessment and triage. Improved modalities in addition to on-scene GCS are needed for determining triage priority in pediatric trauma patients.
