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Published on: March 26, 2019

Blood pressure and outcome after severe pediatric traumatic brain injury

Monica S Vavilala1, Anna Bowen, Arthur M Lam

  • 1Department of Anesthesiology, Harborview Medical Center, University of Washington, Seattle, USA. vavilala@u.washington.edu

The Journal of Trauma
|December 17, 2003
PubMed

Insights

Lower age-appropriate systolic blood pressure (AASBP) percentiles in children with severe traumatic brain injury (TBI) are linked to poor outcomes. Even with normal systolic blood pressure (SBP), an AASBP below the 75th percentile indicates increased risk.

Area of Science:

  • Pediatric critical care medicine
  • Neurotrauma research
  • Clinical outcomes research

Background:

  • The impact of systolic blood pressure (SBP) on outcomes in pediatric severe traumatic brain injury (TBI) requires further clarification.
  • Understanding the role of age-appropriate systolic blood pressure (AASBP) is crucial for managing TBI in children.

Purpose of the Study:

  • To investigate the association between AASBP percentiles and clinical outcomes in children with severe TBI.
  • To determine if low AASBP predicts poor outcomes independently of absolute SBP values.

Main Methods:

  • A cohort of 172 children under 14 years with Glasgow Coma Scale score < 9 was analyzed.
  • Age-appropriate systolic blood pressure (AASBP) percentiles were calculated and correlated with outcomes.
  • Outcome was assessed using the Glasgow Outcome Scale (GOS) at discharge, with GOS < 4 defined as poor outcome.

Main Results:

  • An AASBP below the 75th percentile was significantly associated with poor outcomes (OR, 4.2; 95% CI, 2.1-8.3).
  • Children with SBP ≥ 90 mm Hg and AASBP < 75th percentile had a higher likelihood of poor outcome (OR, 3.5; 95% CI, 1.7-7.3) compared to those with AASBP ≥ 75th percentile.
  • This association persisted even when SBP was maintained at or above 90 mm Hg.

Conclusions:

  • AASBP < 75th percentile is a significant predictor of poor outcome in severe pediatric TBI.
  • Monitoring AASBP is essential for identifying children at risk, even when absolute SBP appears adequate.
  • These findings highlight the importance of age-specific blood pressure management in pediatric TBI care.
Abstract

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