Predictive Value of the Glasgow Coma Scale and the PRISM (Paediatric Risk of Mortality Score) on the Outcome of Craniocerebral Injuries in Children

Abstract

Introduction: The paediatric risk of mortality score (PRISM) and the Glasgow Coma Scale are two of the most well-known, reliable and valid predictors of mortality. Aim: To evaluate the prognostic value of the Glasgow Coma Scale and the PRISM for the outcome of children hospitalized with traumatic brain injuries in the intensive care unit (ICU). Method: The sample is consisted of 252 children with traumatic brain injury who were hospitalized in the ICU of the “Hippokrateio” General Hospital in Thessaloniki. Data were collected according to a specific clinical protocol, which included both the Glasgow Coma Score and PRISM. Statistical analysis performed with the Statistical Package for Social Sciences (SPSS), v. 21.0 included x2, analysis of variance and multivariate logistic regression analysis. Results: The mean age of the children was 6.9 years. The main causes of injury were falls (34.9%), traffic accidents (33.7%) and dragging (19.8%). The mean duration of mechanical ventilation was 8.8 days and mean stay in the ICU was 7.4 days. The fatality rate of the study patients during their stay in the ICU was 10.7% (n=27), 20.6% (n=52) survived with residual disability and 68.7% (n=173) were cured. The patients who died had a statistically significantly lower mean score on the Glasgow Coma Scale (4.8) than those with disabilities (7.2) and those who were cured (9.2). Multivariate logistic regression analysis demonstrated that increased PRISM score (odds ratio [OR]=1.26, 95% confidence interval [CI]=1.16 to 1.37, p<0.001) and decreased score on the Glasgow Coma Scale (OR=0.78, 95% CI=0.58 to 1.06, p=0.11) were correlated with increased fatality. The PRISM and the Glasgow Coma Scale predicted 61% of the variability of fatality, a percentage that indicates significant predictive value. Conclusions: The results from the present study showed that the two scales, Glasgow Coma Scale and PRISM have the same predictive value in relation to fatality after head injury. The determination of the severity of the condition of the paediatric patient by estimation with different scales is important for a wide range of applications in the ICU.