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Mortality in children with severe head trauma: predictive factors and proposal for a new predictive scale
José Roberto Tude Melo1, Federico Di Rocco, Stéphane Blanot
1Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France. robertotude@gmail.com
Insights
Predictors of mortality in severe pediatric traumatic brain injury (TBI) were identified. A new grading scale incorporating age, Glasgow Coma Scale score, hypothermia, hyperglycemia, and coagulation disorders can predict TBI patient mortality risk.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Public health epidemiology
Background:
- Traumatic brain injury (TBI) is a significant global public health concern.
- Identifying secondary brain lesion sources is vital for improving outcomes in pediatric TBI.
- Understanding mortality predictors is crucial for effective TBI management.
Purpose of the Study:
- To determine key predictors of mortality in children with severe TBI.
- To develop a novel grading scale for assessing the risk of death in pediatric TBI patients.
- To validate the accuracy of identified predictors and the proposed scale.
Main Methods:
- Retrospective analysis of medical records from 315 children with severe TBI.
- Utilized multiple logistic regression to identify independent mortality factors.
- Employed receiver-operating characteristic curve analysis to assess scale accuracy.
Main Results:
- Identified independent mortality predictors: age < 2 years, Glasgow Coma Scale (GCS) ≤ 5, accidental hypothermia, hyperglycemia, and coagulation disorders.
- Developed a prognostic scale (0-6) based on these factors.
- The scale demonstrated a mortality risk range from 1% (score 6) to 100% (score 0).
Conclusions:
- Identified independent and modifiable predictors of mortality in pediatric TBI.
- A new grading scale effectively correlates with mortality risk in pediatric TBI.
- The scale offers a valuable tool for risk stratification and management decisions.
Background:
Traumatic brain injury is a public health problem around the world, and recognition of systemic sources of secondary brain lesions is crucial to improve outcome.
Objective:
To identify the main predictors of mortality and to propose a grading scale to measure the risk of death.
Methods:
This retrospective study was based on medical records of children with severe traumatic brain injury who were hospitalized at a level I pediatric trauma center between January 2000 and December 2005. Multiple logistic regression analysis was done to identify independent factors related to mortality. A receiver-operating characteristics curve was performed to verify the accuracy of the multiple logistic regression, and associations that increased mortality were verified.
Results:
We identified 315 children with severe head injury. Median Glasgow Coma Scale score was 6, and median Pediatric Trauma Score was 4. Global mortality rate was 30%, and deaths occurred despite adequate medical management within the first 48 hours in 79% of the patients. Age<2 years (P=.02), Glasgow Coma Scale≤5 (P<10), accidental hypothermia (P=.0002), hyperglycemia (P=.0003), and coagulation disorders (P=.02) were all independent factors predicting mortality. A prognostic scale ranging from 0 to 6 that included these independent factors was then calculated for each patient and resulted in mortality rates ranging from 1% with a score of 6 to 100% with a score of 0.
Conclusion:
Independent and modifiable mortality predictors could be identified and used for a new grading scale correlated with the risk of mortality in pediatric traumatic brain injury.
