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Base deficit correlates with mortality in pediatric abusive head trauma
Camille L Stewart1, Courtenay M Holscher, Ernest E Moore
1University of Colorado School of Medicine, Aurora, CO, USA.
Insights
Delayed medical care in abusive head trauma (AHT) leads to worse outcomes. Higher base deficit (BD) in AHT patients indicates prolonged pre-hospital hypoxia and correlates with increased mortality.
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.
Background/Purpose:
Children suffering from abusive head trauma (AHT) have worse outcomes compared to non-AHT, but the reasons for this are unclear. We hypothesized that delayed medical care associated with AHT causes prolonged pre-hospital hypotension and hypoxia as measured by admission base deficit (BD), and that this would correlate with outcome.
Methods:
We performed a 10-year retrospective chart review of children admitted for AHT at two academic level-I trauma centers. Statistics were performed using Student's t test, chi-square analysis, and multivariate logistic regression, and considered significant at p < 0.05.
Results:
Four-hundred twelve children with AHT were identified, and admission BD was drawn for 148/412 (36%) children, including 104 survivors and 44 non-survivors. Non-survivors had significantly higher BD compared to survivors (12.6 ± 1.6 versus 5.3 ± 0.6, p < 0.001). Non-survivors were more likely to be intubated pre-hospital and get cardiopulmonary resuscitation (CPR) (p < 0.001). Mortality increased with rising BD, according to CPR status. There was no difference in patterns of brain injury between survivors and non-survivors (p > 0.05).
Conclusions:
BD correlates with mortality in children suffering severe AHT. Non-survivors are also more likely to be intubated pre-hospital and require CPR, with no difference in pattern of brain injury, suggesting that secondary injury is a major determinant of outcome in severe AHT.
