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Predictors of survival and severity of disability after severe brain injury in children
L J Michaud1, F P Rivara, M S Grady
1Harborview Injury Prevention and Research Center, Seattle, Washington.
Insights
Predicting survival and disability in children with severe traumatic brain injury (TBI) involves different factors. Early indicators like Injury Severity Score and pupillary response predict survival, while later Glasgow Coma Scale motor scores predict quality of recovery.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Outcome Prediction in Traumatic Brain Injury
Background:
- Severe nonpenetrating traumatic brain injuries (TBIs) in children have significant mortality and long-term disability rates.
- Understanding factors predictive of survival and functional outcomes is crucial for optimizing clinical management and research.
Purpose of the Study:
- To identify factors that predict survival in pediatric patients with severe TBI.
- To identify factors that predict the level of disability in surviving pediatric patients with severe TBI.
Main Methods:
- Retrospective study of 75 children (≤16 years) admitted to a Level I trauma center over 2 years with severe nonpenetrating TBI.
- Analysis of clinical status, Glasgow Coma Scale (GCS) scores, Injury Severity Score (ISS), extracranial injuries, oxygenation, and pupillary responses.
- Factors analyzed for prediction of survival and, separately, for prediction of disability in survivors.
Main Results:
- Overall mortality rate was 33%; good recovery (31%), moderate disability (12%), severe disability (19%), and vegetative state (5%) were observed.
- Injury Severity Score (ISS) and emergency room pupillary responses were most predictive of survival.
- Glasgow Coma Scale (GCS) motor scores at 72 hours and emergency room oxygenation level were most predictive of the quality of survival.
Conclusions:
- Predictive factors for survival differ from those predicting the quality of survival in severely brain-injured children.
- Early injury severity and neurological signs predict survival, while later neurological status and oxygenation predict functional outcomes.
- Findings have implications for clinical care strategies and future research in pediatric TBI.
Abstract:
Seventy-five children, 16 years of age or younger, consecutively admitted to a level I trauma center over a 2-year period with severe nonpenetrating traumatic brain injuries were studied to assess factors predictive of survival and level of disability. The mortality rate was 33%; 31% had good recovery, 12% had moderate disability, 19% had severe disability, and 5% remained in a vegetative state. Factors were analyzed separately for potential effects on survival and, with fatalities excluded, for potential effects on the level of disability in survivors. Clinical status in the field and emergency room, although highly associated with survival, was less predictive of the level of disability in survivors. Glasgow Coma Scale scores 72 hours after injury, especially the motor component, were significantly better predictors of quality of survival. The severity of the brain injury and the presence and severity of extracranial injuries were strongly related both to survival and quality of survival. Chest injuries, in particular, were associated with increased mortality and morbidity, as was level of oxygenation; these factors were highly correlated. Factors most significantly predictive of survival were severity of total injuries as assessed with the Injury Severity Score and pupillary responses in the emergency room; factors most predictive of disability were Glasgow Coma Scale motor responses 72 hours after injury and level of oxygenation in the emergency room. These findings of differential predictive factors for outcomes of survival versus quality of survival have implications relevant both to clinical care and to research involving severely brain-injured children.