Reliability of Glasgow Coma Score in pediatric trauma patients

Background: Discordant assessments of Glasgow Coma Score (GCS) following trauma can result in inappropriate triage. This study sought to determine the reliability of prehospital GCS compared to emergency department (ED) GCS. Methods: We conducted a retrospective review of traumas from 01/2000 to 12/2015 at a Level-1 pediatric trauma center. We evaluated reliability between field and ED GCS using Pearson's correlation. We ascertained the difference between prehospital and ED GCS (delta-GCS). Associations between patient characteristics and delta-GCS were modeled using Poisson and linear regression, adjusting for demographic and clinical covariates. Results: We identified 5306 patients. Pearson's correlation for GCS measurements was 0.57 for ages 0–3, and 0.67–0.77 for other age groups. Mean delta-GCS was highest for age < 3 years (0.95, SD = 2.4). Poisson regression demonstrated that compared to children 0–3 years, higher age was associated with lower delta-GCS (RR 0.65 95% CI 0.56–0.74). Linear regression showed that in those with a delta-GCS, more severe injury (higher ISS, worse ED disposition) and older age were associated with a negative change, signifying decline in score. Conclusions: GCS is generally unreliable in pediatric trauma patients aged 0–3 years, particularly the verbal score component. This may impact accuracy of triage priority for pediatric trauma patients. Level of evidence: III, Prognostic.