Validation of motor component of Glasgow coma scale in lieu of total Glasgow coma scale as a pediatric trauma field triage tool.
The American journal of emergency medicine · 2024-04-21 · Observational study
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.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Children · Mortality & survival · Triage instruments
Related articles
- Determining the Optimal Cutoff Value for the Reverse Shock Index Multiplied by the Glasgow Coma Scale for the Prediction of In-Hospital Mortality in Pediatric Trauma Patients: A Retrospective Cohort Study. (J Clin Med, 2025)
- Do prehospital criteria optimally assign injured children to the appropriate level of trauma team activation and emergency department disposition at a level I pediatric trauma center? (Pediatr Surg Int, 2014)
- Pediatric trauma triage: A Pediatric Trauma Society Research Committee systematic review. (J Trauma Acute Care Surg, 2020)
- Prehospital Reverse Shock Index Times Glasgow Coma Scale as a Predictor for Trauma Intervention in Paediatric Trauma Patients. (J Pediatr Surg, 2025)
- The availability and use of out-of-hospital physiologic information to identify high-risk injured children in a multisite, population-based cohort. (Prehosp Emerg Care, 2009)
- Pediatric Trauma Score (PTS) combined with blood lactate measurement provides clinical treatment guidance and prognosis prediction for children with compound injuries: a prospective study. (Eur J Pediatr, 2026)