Validation of motor component of Glasgow coma scale in lieu of total Glasgow coma scale as a pediatric trauma field triage tool

Shiyi Eileen Yap; Hung Chew Wong; Shu-Ling Chong; Sashikumar Ganapathy; Gene Yong-Kwang Ong

doi:10.1016/j.ajem.2024.04.031

Validation of motor component of Glasgow coma scale in lieu of total Glasgow coma scale as a pediatric trauma field triage tool

Am J Emerg Med. 2024 Apr 21:81:105-110. doi: 10.1016/j.ajem.2024.04.031. Online ahead of print.

Authors

Shiyi Eileen Yap¹, Hung Chew Wong², Shu-Ling Chong³, Sashikumar Ganapathy³, Gene Yong-Kwang Ong³

Affiliations

¹ Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore. Electronic address: eileen.yap.s.y@singhealth.com.sg.
² National University of Singapore, Singapore.
³ Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore.

PMID: 38733662
DOI: 10.1016/j.ajem.2024.04.031

Abstract

Introduction: Prehospital trauma triage and disability assessment of pediatric patients can be challenging on the field, especially in the pre-verbal age group. It would be useful if the same triage tool and criteria can be used for both adults and children to risk-stratify the need of higher acuity of trauma care.

Study objective: We aimed to investigate if using only the motor component of Glasgow Coma Scale (mGCS), as a quick field trauma triage tool, was non-inferior to total GCS (tGCS), and if mGCS <6 was non-inferior to tGCS <14, in predicting the need for intensive care or mortality in the pediatric population.

Methods: We performed a retrospective review of patients <18-years-old, who presented to our emergency department (ED) with moderate (Injury Severity Score (ISS) 9-15) to severe (ISS > 15) traumatic injuries from January 2012 to December 2021. Using ED triage data, mortality and the need for intensive care unit (ICU) admission were used as surrogate outcomes to investigate if mGCS <6 was non-inferior to tGCS <14, and the area-under-the-receiver-operating-characteristic curve (AUROC) was used as a measure of comparability.

Results: Among 582 included for analysis, the median age was 7-years-old (2-12), and most were male (63.4%). 22.4% patients demised or required ICU care. mGCS <6 had an AUROC of 0.75 (95% CI 0.70 to 0.79), which was non-inferior to tGCS <14; AUROC 0.76, (95% CI 0.72 to 0.81), for identifying children requiring ICU management or demised. The results shown here were based on the AUROCs that were used to evaluate the discriminatory ability of tGCS <14 and mGCS <6 in prediction of mortality and the need for ICU care.

Conclusion: Our study showed that mGCS was significantly associated with tGCS, and was non- inferior to the latter as a triage tool in pediatric trauma. It validated the use of mGCS <6 in lieu of tGCS <14 in the pre-hospital field triage of pediatric patients, in identification of children at risk of death or requiring ICU care. Larger prospective, observational studies using on-scene data would be required for more robust validation and determine optimal cut-offs.

Keywords: Glasgow coma scale; Pediatric; Trauma; Triage.