Early prediction of outcome following head injury in children.

A retrospective survey of 166 children aged 15 years or less was made in an attempt to identify which clinical features presenting in the first 24 hours after a head injury might be helpful in predicting the eventual outcome as defined by the Glasgow Outcome Scale. In 88% of the children, the trend of Glasgow Coma Scale score over the first 24 hours was useful. This included children admitted with a score of 3 or 4 and those with a score of 5 or more who did not deteriorate within 24 hours of injury. In this group only 2% of the predictions would have been inaccurate and in only 0.7% would the outcome have been worse than the prediction. The presence of both abnormal plantar and pupillary light reflexes predicted death or significant disability in 99% of cases.