Comparing Prognostic Value of the Pediatric Glasgow Coma Scale and the Glasgow Coma Scale - Pupils Score in Pediatric Traumatic Brain Injury.

IF 0.9 4区医学 Q4 CRITICAL CARE MEDICINE

Journal of Trauma Nursing Pub Date : 2025-09-30 DOI:10.1097/JTN.0000000000000884

Akif Bulut, Nurgül Tekin, Nurcan Özyazıcıoğlu, Elif Başaran, Arzu Oto

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引用次数: 0

Abstract

Background: The Glasgow Coma Scale has been a standard tool for assessing consciousness in trauma patients for five decades, but its utility is limited by the omission of brainstem reflexes such as pupillary response.

Objective: This study aimed to compare the prognostic accuracy of the Pediatric Glasgow Coma Scale (pGCS) and the Pediatric Glasgow Coma Scale - Pupils Score (pGCS-P) in predicting mortality and functional outcomes among pediatric patients with traumatic brain injury (TBI).

Methods: This single-center observational cohort study was conducted from May 2022 to May 2023 at Bursa Training and Research Hospital, Health Sciences University, Turkey. Pediatric patients (age <18 years) presenting with TBI were evaluated for level of consciousness and pupillary responses on admission. Both the pGCS and pGCS-P scores were calculated for each patient. For patients with anisocoria but preserved light reflexes in both pupils, scoring adjustments were made.

Results: Of the 134 patients studied, 59.7% were male, and the mean (SD) age was 6.3 (5.4) years. In-hospital mortality was 12.7%, and 5.1% had unfavorable functional outcomes (UFOs) at discharge. Both the pGCS-P and pGCS demonstrated excellent ability to predict mortality (AUC, 0.97, 95% CI: 0.94-0.99 and 0.97, 95% CI: 0.94-0.96, respectively). There was no statistically significant difference in prognostic performance between the two scores using either binomial (p = .165) or nonparametric (p = .445) analyses (p >.05).

Conclusions: In pediatric patients with TBI, the prognostic accuracy of the pGCS with pupil response (pGCS-P) was comparable to that of the pGCS alone for predicting mortality and UFOs. Incorporation of the pupil score did not significantly improve prognostic discrimination in this cohort.

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比较儿童格拉斯哥昏迷评分和格拉斯哥昏迷评分-瞳孔评分在儿童创伤性脑损伤中的预后价值。

背景：五十年来，格拉斯哥昏迷量表一直是评估创伤患者意识的标准工具，但其效用受到脑干反射如瞳孔反应的遗漏的限制。目的：本研究旨在比较儿童格拉斯哥昏迷量表（pGCS）和儿童格拉斯哥昏迷量表-瞳孔评分（pGCS- p）在预测儿童创伤性脑损伤（TBI）患者死亡率和功能结局方面的预后准确性。方法：该单中心观察队列研究于2022年5月至2023年5月在土耳其卫生科学大学Bursa培训和研究医院进行。结果：134例患者中，男性占59.7%，平均（SD）年龄为6.3（5.4）岁。住院死亡率为12.7%，出院时有5.1%的不良功能结局（UFOs）。pGCS- p和pGCS均表现出极好的预测死亡率的能力（AUC, 0.97, 95% CI: 0.94-0.99和0.97,95% CI: 0.94-0.96）。使用二项分析（p = 0.165）或非参数分析（p = 0.445），两种评分之间的预后表现均无统计学差异（p < 0.05）。结论：在儿童TBI患者中，pGCS与瞳孔反应（pGCS- p）在预测死亡率和不明飞行物方面的预后准确性与pGCS单独预测的准确性相当。在这个队列中，合并小学生评分并没有显著改善预后歧视。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma Nursing CRITICAL CARE MEDICINENURSING&-NURSING

CiteScore

1.20

自引率

10.00%

发文量

106

期刊介绍： Journal of Trauma Nursing (JTN) is the official journal of the Society of Trauma Nurses. The Society of Trauma Nurses believes that trauma is a disease impacting patients through the continuum of care. The mission of STN is to ensure optimal trauma care through education, collaboration, leadership and membership engagement. As the official publication of the Society of Trauma Nurses, the Journal of Trauma Nursing supports the STN’s strategic goals of effective communication, education and patient advocacy with original, peer-reviewed, research and evidence-based articles and information that reflect the highest standard of collaborative care for trauma patients. The Journal of Trauma Nursing, through a commitment to editorial excellence, implements STN’s vision to improve practice and patient outcomes and to become the premiere global nursing organization across the trauma continuum.