{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:11:52Z","timestamp":1791979912138,"version":"4.4.0"},"reference-count":21,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/501100024396","name":"Healthcare Quality Improvement Partnership","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100024396","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,9,19]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>UK hospital admissions: September 2009\u2013February 2010.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>&lt;15 years with head injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>GCS and\/or AVPU at injury scene and in emergency departments (ED).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>Measures used, the equivalence of AVPU to GCS, GCS at the scene predicting GCS in ED, CT results by age, hospital type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Level 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 &lt;5 years: A=15, V=14, P=8, U=3, for 1163 children \u22655 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&lt;15. However diagnostic yield of intracranial injury or depressed fracture was significantly greater for V\/P\/U than GCS&lt;15 :7\/7: 100% (95%\u2009CI 64.6% to 100%) versus 5\/17: 29.4% (95% CI 13.3% to 53.1%). For children &gt;1\u2009year significantly more had a CT scan when GCS&lt;14 was recorded than \u2018V\/P\/U only\u2019 and the diagnostic yield was greater. Prehospital GCS and GCS in the ED were the same for 77.4% (705\/911).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There was a clear correlation between Alert and GCS=15\u2009and between Unresponsive and GCS=3\u2009but 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023216","type":"journal-article","created":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T06:09:15Z","timestamp":1543471755000},"page":"e023216","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["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."],"prefix":"10.1136","volume":"8","author":[{"given":"Amy GL","family":"Nuttall","sequence":"first","affiliation":[{"name":"Division of Population Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie M","family":"Paton","sequence":"additional","affiliation":[{"name":"Division of Population Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison M","family":"Kemp","sequence":"additional","affiliation":[{"name":"Division of Population Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,11,28]]},"reference":[{"key":"2025121510473928000_8.11.e023216.1","unstructured":"NHS Digital. Hospital episode statistics. http:\/\/www.hscic.gov.uk\/hes (Accessed Aug 2015)."},{"key":"2025121510473928000_8.11.e023216.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2013.07.021"},{"key":"2025121510473928000_8.11.e023216.3","unstructured":"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)."},{"key":"2025121510473928000_8.11.e023216.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)93219-8"},{"key":"2025121510473928000_8.11.e023216.5","doi-asserted-by":"publisher","DOI":"10.1007\/BF01405862"},{"key":"2025121510473928000_8.11.e023216.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(14)70120-6"},{"key":"2025121510473928000_8.11.e023216.7","unstructured":"GCS. 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