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Intensive care unit variables and outcome after pediatric traumatic brain injury: a retrospective study of survivors
Cynthia F Salorio1, Beth S Slomine, Anne-Marie Guerguerian
1Kennedy Krieger Institute, Baltimore, MD, USA. salorio@kennedykrieger.org
Insights
Early physiological markers after pediatric traumatic brain injury may predict long-term outcomes. Further research is needed to confirm these findings in children with moderate to severe traumatic brain injury.
Area of Science:
- Pediatric Traumatic Brain Injury
- Neuroscience
- Rehabilitation Medicine
Background:
- Traumatic brain injury (TBI) is a significant cause of childhood death and disability.
- Hypotension is linked to poorer outcomes in pediatric TBI, but the impact of acute hypertension remains unclear.
Purpose of the Study:
- To identify acute physiological variables during early hospitalization that may predict long-term outcomes in children with TBI.
- To investigate the relationship between early physiological status and functional and cognitive outcomes one year post-injury.
Main Methods:
- Retrospective chart review of 57 pediatric TBI survivors (ages 5-17) admitted for rehabilitation.
- Standard of care interventions were applied.
- Outcomes assessed at 1 year using cognitive testing (Wechsler Intelligence Scale for Children, Third Edition) and functional assessment (Disability Rating Scale).
Main Results:
- Early physiological markers of secondary injury after moderate to severe TBI in children may predict long-term outcomes.
- Cognitive and functional outcomes were evaluated one year post-injury.
Conclusions:
- Early physiological variables in pediatric TBI may serve as predictive markers for long-term outcomes.
- Highlights the necessity for longitudinal, systematic, and precise outcome measurements in pediatric TBI research.
- Emphasizes the need for prospective studies to validate the predictive value of acute management variables on diverse outcomes.
Objective:
Traumatic brain injury is a leading cause of death and disability in children. Hypotension has been associated with poor survival and outcome in children after traumatic brain injury, but the effect of acute hypertension is less certain. The objective was to obtain acute physiologic variables during the early hospitalization period in a cohort of children prospectively enrolled in another study.
Design:
Retrospective chart reviews.
Setting:
University-affiliated pediatric rehabilitation center.
Patients:
Fifty-seven survivors, 5-17 yrs of age, admitted for rehabilitation between 1992 and 1995 after sustaining a traumatic brain injury.
Interventions:
Standard of care.
Measurements And Main Results:
Outcomes were assessed at 1 yr postinjury through cognitive testing of the child and parent interview of the child's global functional skills. Cognitive outcome was measured using the Performance IQ from the Wechsler Intelligence Scale for Children, Third Edition. Overall functional outcome was assessed using the Disability Rating Scale.
Conclusions:
This study suggests that early markers of secondary injury after moderate to severe traumatic brain injury in children may be predictive of long-term outcome. This study reinforces the need for longer term, systematic, and more precise measurements of outcomes in children with traumatic brain injury and prospective studies to examine the predictive value of acute management variables on multiple types of outcomes after traumatic brain injury in children.
