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Variation in therapy and outcome for pediatric head trauma patients
J M Tilford1, P M Simpson, T S Yeh
1Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA.
Insights
Pediatric head trauma care varies by hospital, but seizure medications may reduce mortality. Further research is needed to confirm these findings in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Health services research
Background:
- Pediatric head trauma is a significant cause of morbidity and mortality.
- Variations in treatment and outcomes exist across pediatric intensive care units (PICUs).
- Understanding these variations is crucial for improving patient care.
Purpose of the Study:
- To examine variations in therapies and outcomes for pediatric head trauma patients.
- To identify factors influencing treatment and mortality in PICUs.
- To assess the impact of specific therapies on patient outcomes.
Main Methods:
- Prospective data collection from 477 pediatric head trauma patients across three PICUs.
- Severity of illness assessed using physiological derangement.
- Therapies evaluated using the Therapeutic Intervention Scoring System.
- Intracranial pressure monitoring and outcomes (Pediatric Overall Performance Category) recorded.
- Logistic regression used to identify risk factors for mortality and protective effects of therapies.
Main Results:
- Overall mortality rate was 7.8%, with higher rates in infants (<1 year).
- Patient characteristics did not correlate with therapy use or standardized mortality rates.
- Significant variation observed in the use of paralytic agents, seizure medications, hypothermia, and intracranial pressure monitoring across PICUs.
- Seizure medication use was significantly associated with reduced mortality risk (OR=0.17).
Conclusions:
- Therapies and outcomes for pediatric head trauma patients differ significantly between PICUs.
- Increased use of seizure medications may improve outcomes in pediatric head trauma.
- Randomized controlled trials are needed to confirm the protective effect of seizure prophylaxis.
Objective:
This study was undertaken to examine variation in therapies and outcome for pediatric head trauma patients by patient characteristics and by pediatric intensive care unit. Specifically, the study was designed to examine severity of illness on admission to the pediatric intensive care unit, the therapies used during the pediatric intensive care unit stay, and patient outcomes.
Data Sources And Setting:
Consecutive admissions from three pediatric intensive care units were recorded prospectively (n = 5,749). For this study, all patients with an admitting diagnosis of head trauma were included (n = 477). Data collection occurred during an 18-month period beginning in June 1996. All of the pediatric intensive care units were located in children's hospitals, had residency and fellowship training programs, and were headed by a pediatric intensivist.
Methods:
Admission severity was measured as the worst recorded physiological derangement during the period
Results:
The overall mortality rate for the entire sample was 7.8%. Mortality rates for children
Conclusions:
Therapies and outcomes vary across pediatric intensive care units that care for children with head injuries. Increased use of seizure medications may be warranted based on data from this observational study. Large randomized controlled trials of seizure prophylaxis in children with head injury have not been conducted and are needed to confirm the findings presented here.
