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Elevated initial blood glucose levels and poor outcome following severe brain injuries in children
L J Michaud1, F P Rivara, W T Longstreth
1Department of Rehabilitation Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington.
Insights
Elevated blood glucose levels in children with severe brain injuries are linked to poorer neurological outcomes. Higher initial glucose levels predict worse results, even when considering injury severity.
Area of Science:
- Pediatric Neurology
- Trauma Care
- Endocrinology
Background:
- Severe brain injuries in children can lead to significant neurological deficits.
- The role of hyperglycemia in pediatric traumatic brain injury outcomes requires further elucidation.
Purpose of the Study:
- To investigate the association between initial blood glucose levels and neurological outcomes in pediatric patients with severe brain injuries.
- To identify predictors of outcome in this vulnerable population.
Main Methods:
- Retrospective review of 54 pediatric patients (≤16 years) with Glasgow Coma Scale score ≤8.
- Analysis of initial blood glucose levels, injury severity indicators, and neurological outcomes (death, vegetative state, good recovery, moderate/severe disability).
- Logistic regression modeling to predict outcome based on Glasgow Coma Scale score and blood glucose levels.
Main Results:
- Patients with poor outcomes (death/vegetative state) had significantly higher mean admission blood glucose levels (288 mg/100 mL) compared to those with better outcomes (194 mg/100 mL).
- Blood glucose levels correlated with brain injury severity, a known outcome predictor, but not with extracranial injury severity.
- A logistic regression model including Glasgow Coma Scale score and initial blood glucose level predicted outcomes. Patients with glucose ≥250 mg/100 mL had an 8.3 times higher odds of a poor outcome.
Conclusions:
- Initial blood glucose levels are a significant predictor of neurological outcomes in children with severe brain injuries.
- Incorporating blood glucose levels into prognostic scores, particularly for patients with levels ≥250 mg/100 mL, can improve outcome prediction beyond the Glasgow Coma Scale score alone.
Abstract:
To determine whether elevations in blood glucose levels were related to neurologic outcomes following severe brain injuries in children, 54 patients 16 years of age or younger admitted to a regional trauma center with a Glasgow Coma Scale score of 8 or less over a 2-year period were retrospectively reviewed. The mean initial blood glucose level on hospital admission was significantly higher in the 16 patients with outcomes of death or vegetative state in comparison with that of the 38 patients with outcomes of good recovery, moderate disability,or severe disability (288 mg/100 mL vs. 194 mg/100 mL, t = -2.74, p = 0.01). Blood glucose levels correlated significantly with indicators of the severity of the brain injury, which were also related to outcome. In contrast, blood glucose levels did not correlate with indicators of the severity of the extracranial injuries, although the latter were significantly related to outcome. Logistic regression analysis resulted in a model for prediction of outcome which included the Glasgow Coma Scale score on admission and the initial blood glucose level. The odds ratio of a poor outcome in this model in patients with blood glucose levels greater than or equal to 250 mg/100 mL relative to those with lower levels was 8.3 (95% confidence interval 1.3-53.6). A simple prognostic score was derived from the logistic regression which improved upon the prediction of outcome using the Glasgow Coma Scale score alone in those patients with initial blood glucose levels greater than or equal to 250 mg/100 mL.(ABSTRACT TRUNCATED AT 250 WORDS)