To what extent are GCS and AVPU equivalent to each other when assessing the level of consciousness of children with head injury? A cross-sectional study of UK hospital admissions.

BMJ Open - Tập 8 Số 11 - Trang e023216 - 2018
Amy Nuttall1, Katie M Paton1, Alison Kemp1
1Division of Population Medicine, Cardiff University, Cardiff, UK

Tóm tắt

ObjectiveTo evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury.DesignCross sectional study.SettingUK hospital admissions: September 2009–February 2010.Patients<15 years with head injury.InterventionsGCS and/or AVPU at injury scene and in emergency departments (ED).Main outcomeMeasures used, the equivalence of AVPU to GCS, GCS at the scene predicting GCS in ED, CT results by age, hospital type.ResultsLevel of consciousness was recorded in 91% (5168/5700) in ED (43%: GCS/30.5%: GCS+AVPU/17.3%: AVPU) and 66.1% (1190/1801) prehospital (33%: GCS/26%GCS+AVPU/7%: AVPU). Failure to record level of consciousness and the use of AVPU were greatest for infants. Correlation between AVPU and median GCS in 1147 children <5 years: A=15, V=14, P=8, U=3, for 1163 children ≥5 years: A=15, V=13, P=11, U=3. There was no significant difference in the proportion of infants who had a CT whether AVPU=V/P/U or GCS<15. However diagnostic yield of intracranial injury or depressed fracture was significantly greater for V/P/U than GCS<15 :7/7: 100% (95% CI 64.6% to 100%) versus 5/17: 29.4% (95% CI 13.3% to 53.1%). For children >1 year significantly more had a CT scan when GCS<14 was recorded than ‘V/P/U only’ and the diagnostic yield was greater. Prehospital GCS and GCS in the ED were the same for 77.4% (705/911).ConclusionThere was a clear correlation between Alert and GCS=15 and between Unresponsive and GCS=3 but a wider range of GCS scores for responsive to Pain or Voice that varied with age. AVPU was valuable at initial assessment of infants and did not adversely affect the proportion of infants who had head CT or the diagnostic yield.

Từ khóa


Tài liệu tham khảo

NHS Digital. Hospital episode statistics. http://www.hscic.gov.uk/hes (Accessed Aug 2015).

10.1016/j.injury.2013.07.021

National Institute for Health and Clinical Excellence. Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults. https://www.nice.org.uk/guidance/cg176/resources/guidance-head-injury-pdf (Accessed 29 July/ 2015).

10.1016/S0140-6736(02)93219-8

10.1007/BF01405862

10.1016/S1474-4422(14)70120-6

GCS. Child’s Glasgow Coma Scale. http://www.bpna.org.uk/audit/GCS.PDF (Accessed 29 Jul 2015).

10.1016/j.aenj.2012.06.002

Baker, 2008, Reviewing the application of the Glasgow Coma Scale: Does it have interrater reliability?, British Journal of Neuroscience Nursing, 4, 342, 10.12968/bjnn.2008.4.7.30674

Zuercher, 2009, The use of Glasgow Coma Scale in injury assessment: a critical review, Brain Inj, 23, 371, 10.1080/02699050902926267

American College of Surgeons’ Committee on Trauma. Advanced trauma life support for doctors. 1977;6.

Matthew, 1966, Acute barbiturate poisoning—a review of two years experience, QJM, 35, 539

Mackay, 2000, Association between the assessment of conscious level using the AVPU system and the Glasgow coma scale, Prehospital Immediate Care, 4, 17

10.1136/archdischild-2015-308424

VassarStats. Website for statistical computation. 2014. Available at http://vassarstats.net/prop1.html.

10.1136/archdischild-2015-309078

Raman, 2011, Comparison of alert verbal painful unresponsiveness scale and the Glasgow Coma Score, Indian Pediatr, 48, 331

Hoffmann, 2016, Lehner M, et al.Z (2016) Comparison of the AVPU scale and the pediatric GCS in prehospital setting, Prehospital Emergency Care, 20:4, 493, 10.3109/10903127.2016.1139216

10.1016/0895-4356(96)00013-3

10.1111/j.1365-2044.2004.03526.x

10.1016/j.annemergmed.2004.03.028

Thông tin
Thông tin xuất bản

BMJ Open

Tập 8 Số 11

e023216

Thông tin tác giả