Base deficit correlates with mortality in pediatric abusive head trauma

Area of Science:

• Pediatric critical care medicine
• Trauma surgery
• Neurology

Background:

• Abusive head trauma (AHT) is associated with poorer outcomes in children.
• The underlying reasons for these worse outcomes remain unclear.
• Delayed medical care may contribute to prolonged pre-hospital physiological compromise.

Purpose of the Study:

• To investigate the association between pre-hospital physiological compromise, measured by admission base deficit (BD), and outcomes in children with AHT.
• To determine if BD correlates with mortality in pediatric AHT cases.

Main Methods:

• Retrospective chart review of children admitted for AHT over 10 years at two level-I trauma centers.
• Statistical analysis included Student's t test, chi-square, and multivariate logistic regression.
• Admission BD was analyzed in relation to survival status, pre-hospital interventions, and CPR.

Main Results:

• A total of 412 children with AHT were identified; 148 had admission BD measured.
• Non-survivors exhibited significantly higher admission BD (12.6 ± 1.6) compared to survivors (5.3 ± 0.6).
• Higher BD correlated with increased mortality, particularly in conjunction with pre-hospital intubation and CPR.

Conclusions:

• Admission base deficit (BD) is a significant correlate of mortality in severe pediatric abusive head trauma.
• Non-survivors were more likely to require pre-hospital intubation and CPR.
• The absence of differences in brain injury patterns suggests secondary injury mechanisms significantly impact outcomes in severe AHT.