Validation of the French translation of the Glasgow Outcome Scale – Extended, Pediatric version (GOS-E Peds): Clinical utility in assessing outcome in children and adolescents following acquired brain injury (ABI)
Dr Mathilde CHEVIGNARDa, Mrs Bernadette KERROUCHEb, Dr Katia LINDc, Mr Dominique DREYFUSd, Dr Hanna TOUREa, Dr Dominique BRUGELa, Prof Sue BEERSe
a Service de Rééducation des Pathologies Neurologiques Acquises de l'Enfant - Hôpitaux de Saint-Maurice, b Centre de Suivi et d’Insertion pour Enfants et Adolescents avec Lésion Cérébrale Acquise - Hôpitaux de Saint Maurice, c Service de Pédiatrie Générale - Hôpital Necker Enfants Malades - France, d Education Nationale - Toulouse, e University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Introduction: The GOS-E Pediatric version allows measuring overall outcome in children and adolescents following ABI. Scores range from 1: upper good recovery, to 7: vegetative state.
Objectives: to validate the French translation of the GOS-E Peds in children with (ABI) of various severity and stages post-injury.
Methods: The GOS-E Peds was used in a PMR department devoted to children with ABI, in three groups of patients: (1) patients shortly hospitalised post-ABI: GOS-E Peds was rated upon admission, at 3 and 6 months post-injury; (2) patients several years post-injury, requiring services of a multi-disciplinary outreach team; (3) patients followed-up on simple medical clinics. The type and severity of ABI were collected.
Results: 398 patients were included [2/3 boys; mean age at injury 6 years (SD=4)].
In group 1 (n=124), mean (SD) GOS-E Peds scores were 5.9(.77) upon admission, 5.12(1.2) at 3-months (n=99) and 4.88(1.45) at 6-months (n=83); scores were significantly worse in case of hemiplegia (66%). GOS-E Peds improved over time (0-3 months p<0.0001; 3-6 months p=0.001). Although age at injury was not correlated with initial rating of GOS-E Peds (r=-.18), younger age at injury was correlated to worse GOS-E Peds scores at 3 and 6 months (r=-.3 and -.44; p<0.001).
In group 2, 101 patients were cross-sectionally assessed by the outreach team in April 2014 [mean age 14.8 (SD=4) years]. Mean GOS-E Peds was 3.95 (SD=1.4). Factors influencing GOS-E Peds were presence of cerebellar signs, younger age at injury (r=-.29; p=0.003) and lower intellectual ability (r=-.27; p=0.008).
In group 3, 173 patients consecutively seen in clinics were assessed [mean age 10.4 years (SD=4.5)]. Mean GOS-E Peds score was 3.3 (SD=1.5). Presence of hemiplegia and cerebellar signs were significantly related to GOS-E Peds scores.
Duration of coma, presence of diffuse brain injury and epilepsy negatively influenced GOS-E Peds scores in the three groups.
Conclusions: The GOS-E Peds has good sensitivity to change, and higher levels when children need a multi-disciplinary outreach team in the long term, than when they require simple clinic follow-up. Young age at injury, diffuse brain injury, epilepsy, motor impairments, and intellectual ability all significantly influence overall outcome.
Keywords : traumatic brain injury, acquired brain injury, child, adolescent, overall outcome, independence level, predictor, outcome