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Traumatic brain injury in childhood: intensive care time series data and outcome
P A Jones1, P J D Andrews, V J Easton
1Department of Child Life and Health, University of Edinburgh, Royal Hospital for Sick Children, Edinburgh, Scotland, UK.
Insights
Establishing age-specific physiological norms is crucial for identifying secondary brain injury in children after head trauma. Abnormal cerebral perfusion pressure (CPP) duration in children significantly predicts mortality and poor outcomes post-traumatic brain injury.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Clinical physiology
Background:
- Secondary brain injury following traumatic brain injury (TBI) in children requires age-specific monitoring.
- Existing physiological norms may not accurately reflect the status of pediatric TBI patients.
Purpose of the Study:
- To quantify secondary physiological derangements in children of varying ages post-TBI.
- To establish age-specific limits for physiological parameters.
- To correlate physiological derangements with 12-month outcomes.
Main Methods:
- Prospective collection of time-series physiological data (ICP, ABP, CPP, SpO2, temperature, HR) from ICU monitors.
- Identification of abnormal physiological recordings exceeding age-specific limits for >5 minutes.
- Calculation of cumulative duration of derangement for each parameter.
- Univariate and multivariate logistic regression to identify outcome predictors.
Main Results:
- Age-specific physiological comparisons enable realistic assessments in pediatric TBI.
- Duration of age-specific cerebral perfusion pressure (CPP) derangement was a significant predictor of outcome.
- CPP derangement correlated with mortality (p=0.003) and poor functional outcome (Glasgow Outcome Score 1-3 vs. 4-5, p=0.004).
Conclusions:
- Age-specific physiological monitoring is essential for managing pediatric TBI.
- Abnormal CPP duration is a key indicator of adverse outcomes in pediatric TBI.
- This study provides a framework for utilizing age-specific physiological data to predict TBI outcomes in children.
Abstract:
Age-specific norms are necessary to determine potential secondary brain insult after head injury in children. We describe and quantify the secondary physiological derangement recorded in children of different ages following traumatic brain injury, and relate it to outcome at 12 months post-injury. Prospective time-series data (including intracranial pressure, arterial blood pressure, cerebral perfusion pressure, oxygen saturation, temperature and heart rate) downloaded from ICU monitors, were examined to identify abnormal (i.e. outside normal age-specific limits) recordings lasting more than 5 min. Cumulated total duration of derangement was calculated for each parameter and as a percentage of the time that the ICP monitor was in situ. Univariate and multivariate logistic regression modelling was used to evaluate predictors of outcome. Age-specificity allows realistic comparisons of physiological data among children. Duration of age-specific derangement of CPP was found to predict outcome (dead v. alive: p = 0.003 and Glasgow Outcome Score 1-3 v. 4-5, i.e. poor v. independent outcome p = 0.004).