The motor response to stimulation predicts outcome as well as the full Glasgow Coma Scale in children with severe head injury

摘要

Objectives: To evaluate how well the full Glasgow Coma Scale and the motor response, which is a subscore of the Glasgow Coma Scale, predict the outcome in children who have sustained a traumatic brain injury. The best scores in the first 24 hrs were used.Design: A retrospective observational study.Setting: A pediatric intensive care unit.Patients: Children admitted between January 1997 and December 1999.Interventions: None.Measurements and Main Results: Recovery with independent function (good outcome), or death, persistent coma, or dependent (bad outcome) at 6 months after the injury. Complete information was available for 130 patients. Both the full Glasgow Coma Scale and the motor response predicted outcome well: the area underthe receiver operating characteristic plot was 0.88 (95% confidence interval, 0.82-0.95) for the full score and 0.89 (0.82-0.95) for the motor response.Conclusions: Both the full Glasgow Coma Scale score and the motor response provide a useful indication of long-term outcome, although neither score is sufficiently accurate to be used to limit treatment. The full Glasgow Coma Scale does not have a linear relationship with mortality, and there is poor interobserver agreement. The motor response should be used in children in preference to the full Glasgow Coma Scale; the predictive power is equivalent to the full Glasgow Coma Scale, there is a linear relationship to mortality, and it is easier to collect accurately.