Outcomes and prognostic factors of pediatric patients with a Glasgow Coma Score of 3 after blunt head trauma

• Published in: Child's nervous system 2020-11, Vol.36 (11), p.2657-2665
• Main Authors: Trimble, Duncan J., Parker, Samantha L., Zhu, Liang, Cox, Charles S., Kitagawa, Ryan S., Fletcher, Stephen A., Sandberg, David I., Shah, Manish N.
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Original Article
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-020-04637-z

Purpose This study aims to assess outcomes of pediatric patients with blunt traumatic brain injury (TBI) with a presenting Glasgow Coma Score (GCS) of 3. Methods After local institutional review board approval, we identified patients ages 0 to15 years with blunt TBI and a reported GCS of 3 between 2007 and 2017 from a pediatric level 1 trauma center prospective registry. Exclusion criteria were cardiac death on arrival and penetrating injury. We recorded clinical variables from patients with a non-pharmacologic GCS of 3 and pupillary exam documented by a neurosurgical attending or resident. The original Glasgow Outcome Scale (GOS) was used to compare with other studies. Importance of variables to survival was calculated. Results A total of 88 patients (mean age 6.9 years) were included with a mortality rate of 68%. Twelve percent had a poor long-term outcome (GOS 2 or 3) while 20% had a good long-term outcome (GOS 4 or 5). Median follow-up was 1.8 years. Initial group comparison revealed patients in group 1 (survivors) had less hypotension on arrival (14% SBP