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Young age as a risk factor for impaired cerebral autoregulation after moderate to severe pediatric traumatic brain
Serena S Freeman1, Yuthana Udomphorn, William M Armstead
1University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.
Insights
Young children under 4 years old with traumatic brain injury (TBI) exhibit impaired cerebral autoregulation and poorer outcomes. Age is a significant risk factor, independent of injury severity.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Trauma Surgery
Background:
- Cerebral autoregulation (CA) mechanisms in pediatric traumatic brain injury (TBI) remain poorly understood.
- Age-specific differences in CA following TBI have not been extensively studied.
Purpose of the Study:
- To compare CA between young children (<4 years) and older children (≥4 years) with TBI.
- To identify age as a potential risk factor for impaired CA in pediatric TBI.
Main Methods:
- Retrospective analysis of prospectively collected data from children (≤16 years) with moderate to severe TBI.
- Cerebral autoregulation index (CAI) assessed within 72 hours post-TBI; impaired CA defined as CAI < 0.4.
- Glasgow Outcome Score (GOS) measured at 12 months.
Main Results:
- Children younger than 4 years demonstrated a higher incidence of impaired CA (8/10 vs. 7/27, P=0.006).
- Younger children also experienced worse 12-month outcomes (GOS 3.0±1.0 vs. 4.0±1.0, P=0.02).
- Age < 4 years (aOR 12.2) and lower Glasgow Coma Scale score were independently associated with impaired CA.
Conclusions:
- Younger age (<4 years) is a significant risk factor for impaired CA in pediatric TBI, irrespective of injury severity.
- Age-related physiological factors may influence CA maintenance and recovery post-TBI in children.
Background:
Little is known about age and cerebral autoregulation in children with traumatic brain injury (TBI). The authors compared cerebral autoregulation between young (aged <4 yr) and older (aged > or =4 yr) children with TBI.
Methods:
After University of Washington's institutional review board approval, a retrospective analysis of prospectively collected data (May 2002 and June 2007) was performed. Eligibility criteria included age 16 yr or younger, moderate to severe (admission Glasgow Coma Scale score <13) TBI, TBI on computed tomography scan, and tracheal intubation. Cerebral autoregulation testing was performed within 72 h after TBI, and autoregulation was quantified using the autoregulatory index. An autoregulatory index less than 0.4 represents impaired cerebral autoregulation. The 12-month Glasgow outcome score was measured. Data are presented as mean +/- SD or range.
Results:
Thirty-seven children (8.9 +/- 5.1 yr; 0.8-16 yr) were enrolled. Children younger than 4 yr had a higher incidence of impaired cerebral autoregulation (8 of 10 vs. 7 of 27; P = 0.006) and worse 12-month outcome (Glasgow outcome score 3.0 +/- 1.0 vs. 4.0 +/- 1.0; P = 0.02) than older children. Age less than 4 yr (adjusted odds ratio, 12.2; 95% confidence interval, 1.5-98.5) and low Glasgow Coma Scale score (adjusted odds ratio for higher Glasgow Coma Scale, 0.53; 95% confidence interval, 0.30-0.96) were independently associated with impaired cerebral autoregulation.
Conclusions:
Age less than 4 yr was a risk factor for impaired cerebral autoregulation, independent of TBI severity. Age-related factors may play a role in the mechanisms maintaining or worsening cerebral autoregulation in children after TBI.
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