Comparing AVPU and Glasgow Coma Scales Among Children Seen by Emergency Medical Services.

Autor:	Ramgopal S; Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center.; Stanley Manne Children's Research Institute, Chicago, Illinois., Horvat CM; Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Cash RE; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts., Pelletier JH; Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron Ohio.; Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio., Martin-Gill C; Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Macy ML; Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center.; Stanley Manne Children's Research Institute, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2024 Aug 01; Vol. 154 (2).
DOI:	10.1542/peds.2024-066168
Abstrakt:	Objectives: Consciousness assessment is an important component in the prehospital care of ill or injured children. Both the Glasgow Coma Scale (GCS) and the Alert, Verbal, Pain, Unresponsive (AVPU) scale are used for this purpose. We sought to identify cut points for the GCS to correspond to the AVPU scale for pediatric emergency medical services (EMS) encounters. Methods: We conducted a retrospective cross-sectional analysis using the 2019-2022 National EMS Information System data set, including children (<18 years) with a GCS and AVPU score. We evaluated several approaches to develop cut points for the GCS within the AVPU scale and reported measures of performance. Results: Of 6 186 663 pediatric encounters, 4 311 598 with both GCS and AVPU documentation were included (median age was 10 years [interquartile range 3-15]; 50.9% boys). Lower AVPU scores correlated with life-sustaining procedures, including those for airway management, seizure, and cardiac arrest. Optimal GCS cut points obtained via a grid-based search were 14 to 15 for alert, 11 to 13 for verbal, 7 to 10 for pain, and 3 to 6 for unresponsive. Overall accuracy was 0.95, with kappa of 0.61. Intraclass F1 statistics were lower for verbal (0.37) and pain (0.50) categories compared with alert (0.98) and unresponsive (0.78). Conclusions: We developed a cross-walking between the AVPU and GCS scales. Overall performance was high, though performance within the verbal and pain categories was lower. These findings can be useful to enhance clinician handovers and to aid in the development of EMS-based prediction models. (Copyright © 2024 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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