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Published on: May 26, 2023
Early resuscitation of children with moderate-to-severe traumatic brain injury
Michelle Zebrack1, Christopher Dandoy, Kristine Hansen
1Division of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City Utah, USA. michelle.zebrack@hsc.utah.edu
Insights
Hypotension and hypoxia are common in pediatric traumatic brain injury. Prompt treatment of hypotension significantly improves survival and reduces disability in children with TBI.
Area of Science:
- Pediatric critical care
- Neurotrauma research
- Emergency medicine
Background:
- Traumatic brain injury (TBI) is a major cause of childhood mortality and morbidity.
- Established guidelines aim to prevent secondary brain injury from hypotension and hypoxia.
- Early management is crucial for improving outcomes in pediatric TBI.
Purpose of the Study:
- To determine the prevalence of hypotension and hypoxia in early pediatric TBI care.
- To assess the monitoring and treatment of these conditions.
- To evaluate the association between hypotension/hypoxia management and patient outcomes.
Main Methods:
- Retrospective analysis of 299 children with moderate-to-severe TBI.
- Inclusion of data from prehospital and emergency department phases.
- Recording of vital signs and medical provider interventions for hypotension/hypoxia.
Main Results:
- Hypotension occurred in 39% and hypoxia in 44% of pediatric TBI cases.
- Treatment attempts for hypotension were made in only 48% of cases.
- Untreated hypotension increased odds of death (3.4x) and disability (3.7x); hypoxia treatment was less critical unless hypotension was present.
Conclusions:
- Hypotension and hypoxia are frequent complications in pediatric TBI.
- A significant portion of children (approx. one-third) lack adequate early monitoring.
- Intervention for hypotension and hypoxia markedly improved patient outcomes.
Objectives:
Traumatic brain injury is a leading cause of death and disability in children. Guidelines have been established to prevent secondary brain injury caused by hypotension or hypoxia. The purpose of this study was to identify the prevalence, monitoring, and treatment of hypotension and hypoxia during "early" (prehospital and emergency department) care and to evaluate their relationship to vital status and neurologic outcomes at hospital discharge.
Methods:
This was a retrospective study of 299 children with moderate-to-severe traumatic brain injury presenting to a level 1 pediatric trauma center. We recorded vital signs and medical provider response to hypotension and/or hypoxia during all portions of early care.
Results:
Blood pressure (31%) and oxygenation (34%) were not recorded during some portion of "early care." Documented hypotension occurred in 118 children (39%). An attempt to treat documented hypotension was made in 48% (57 of 118 children). After adjusting for severity of illness, children who did not receive an attempt to treat hypotension had an increased odds of death of 3.4 and were 3.7 times more likely to suffer disability compared with treated hypotensive children. Documented hypoxia occurred in 131 children (44%). An attempt to treat hypoxia was made in 92% (121 of 131 children). Untreated hypoxia was not significantly associated with death or disability, except in the setting of hypotension.
Conclusions:
Hypotension and hypoxia are common events in pediatric traumatic brain injury. Approximately one third of children are not properly monitored in the early phases of their management. Attempts to treat hypotension and hypoxia significantly improved outcomes.
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