Assessing the validity of caregiver-perceived severity in pediatric traumatic brain injury: A comparative analysis with the Glasgow Coma Scale.

Abstract

PurposeThe Glasgow Coma Scale (GCS) is the gold standard in assessing severity for traumatic brain injury (TBI). This study aimed to compare GCS-rated severity to caregiver-perceived severity. Researchers assessed levels of agreement and explored which factors explained any differences and predicted whether a GCS score was provided.MethodsCaregiver-perceived severity, demographic, and medical information was collected via electronic survey from 107 youth with TBI. GCS-rated severity was collected via medical-chart review.ResultsThe strength of agreement fluctuated by severity (mild/concussion k = 0.60, moderate k = 0.1, severe k = 0.64). Caregiver perceptions were more severe in 62% of cases. No medical or demographic variables explained discrepancies. GCS was documented in 38% of medical records. Binomial regression modeling found that participants seen in the emergency department were most likely to receive a GCS rating.ConclusionResults suggest that caregivers may be reliable evaluators of their child's TBI severity, particularly for those classified as mild or severe injuries with GCS ratings. Allowing caregiver-perceived severity ratings could increase inclusivity in research, so participation is not limited to children who go to the emergency department. More research is needed to determine if caregiver-perceived severity tracks with long-term outcomes or if caregivers base severity ratings on factors outside of the initial injury event.