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The motor response to stimulation predicts outcome as well as the full Glasgow Coma Scale in children with severe head injury*

Fortune, Peter-Marc BM, BSc, MA, PhD, FRCPCH; Shann, Frank MD, FRACP, FJFICM

Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e3181c014ab
Feature Articles

Objectives: To evaluate how well the full Glasgow Coma Scale and the motor response, which is a subscore of the Glasgow Coma Scale, predict the outcome in children who have sustained a traumatic brain injury. The best scores in the first 24 hrs were used.

Design: A retrospective observational study.

Setting: A pediatric intensive care unit.

Patients: Children admitted between January 1997 and December 1999.

Interventions: None.

Measurements and Main Results: Recovery with independent function (good outcome), or death, persistent coma, or dependent (bad outcome) at 6 months after the injury. Complete information was available for 130 patients. Both the full Glasgow Coma Scale and the motor response predicted outcome well: the area under the receiver operating characteristic plot was 0.88 (95% confidence interval, 0.82–0.95) for the full score and 0.89 (0.82–0.95) for the motor response.

Conclusions: Both the full Glasgow Coma Scale score and the motor response provide a useful indication of long-term outcome, although neither score is sufficiently accurate to be used to limit treatment. The full Glasgow Coma Scale does not have a linear relationship with mortality, and there is poor interobserver agreement. The motor response should be used in children in preference to the full Glasgow Coma Scale; the predictive power is equivalent to the full Glasgow Coma Scale, there is a linear relationship to mortality, and it is easier to collect accurately.

Author Information

From Paediatric Care (P-MF), Royal Manchester Children’s Hospital, Manchester, UK; and Intensive Care (FS), Royal Children’s Hospital, Melbourne, Victoria, Australia.

The authors have not disclosed any potential conflicts of interest.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies