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Anergy in pediatric head trauma patients
N W Wilson1, A Gooding, B Peterson
1Department of Pediatrics, University of California-San Diego, La Jolla 92093.
Insights
Children with severe trauma who show no delayed-type hypersensitivity (anergic) are more prone to infection. This immune test can identify children at higher risk for nosocomial infections after injury.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Trauma surgery
Background:
- Severe blunt trauma in children can impair cellular immune function.
- Assessing immune status is crucial for predicting infection risk in pediatric trauma patients.
Purpose of the Study:
- To evaluate cellular immune function in children post-severe blunt trauma.
- To determine if delayed-type hypersensitivity skin testing can predict infection risk.
Main Methods:
- Utilized the CMI Multitest system to assess delayed-type hypersensitivity in 25 pediatric trauma patients.
- Monitored patients for infection over 3 weeks.
- Measured circulating lymphocyte subpopulations (T101, CD4, CD8, B cells) in a subset of patients.
Main Results:
- 56% of children were anergic (no skin test reaction).
- Anergic children had a significantly higher infection rate (79%) compared to non-anergic children (27%).
- Absolute B cell counts decreased significantly by day 7 post-injury, while T-cell populations remained stable.
Conclusions:
- Anergy in pediatric trauma patients is associated with increased susceptibility to infection.
- Delayed-type hypersensitivity skin testing is a valuable tool for identifying children at high risk for nosocomial infections.
- Pediatric trauma impacts B cell numbers but not T cell populations, differing from adult responses.
Abstract:
To assess cellular immune function in children following severe blunt trauma, 25 children (mean: age, 7.1 years; Injury Severity Score, 34.9; and Glascow Coma Score, 5.6) admitted with severe trauma were examined with the use of the CMI Multitest system (Merieux Institute, Miami, Fla) to test delayed-type hypersensitivity. Patients were monitored for evidence of infection for the next 3 weeks. Ten children (mean: age, 6.2 years; Injury Severity Score, 31.2; and Glascow Coma Score, 5.4) admitted with severe trauma had the percentage of circulating lymphocyte subpopulations (pan-T cell marker T101, CD4, CD8, and B cells) measured on day 1 and then weekly for 3 weeks. Fourteen (56%) of the 25 children had no reaction to any of the skin tests (anergic). Eleven (79%) of 14 anergic patients became infected, while three (27%) of 11 of the nonanergic children became infected. There were no significant changes in pan-T cell marker T101, CD4, or CD8 lymphocyte populations in the 3 weeks following injury; however, absolute numbers of circulating B cells dropped significantly by day 7. These data indicate that children with severe trauma who are anergic are significantly more susceptible to infection. Unlike the results reported previously in adult trauma patients, these children had no significant fluctuations in T-cell populations; however, there was a significant decrease in circulating B cells in the first week. The use of the delayed-type hypersensitivity skin test can aid in identifying which patients are at an increased risk for nosocomial infection.