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Hyperglycemia: an independent risk factor for poor outcome in children with traumatic brain injury*
Benjamin Elkon1, Jay Riva Cambrin, Eliotte Hirshberg
11Department of Pediatrics, University of Utah, Salt Lake City, UT. 2Department of Neurosurgery, University of Utah, Salt Lake City, UT. 3Department of Internal Medicine, University of Utah, Salt Lake City, UT.
Insights
Severe hyperglycemia in children with traumatic brain injury is linked to worse outcomes. Even brief periods of high blood glucose significantly increase the risk of poor Glasgow Outcome Score in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Metabolic disorders in critical illness
Background:
- Hyperglycemia is common in children with traumatic brain injury (TBI).
- The association between hyperglycemia severity, duration, and outcomes in pediatric TBI is not fully understood.
- Optimal management strategies for hyperglycemia in this population require further investigation.
Purpose of the Study:
- To characterize hyperglycemia severity and duration in pediatric TBI survivors and non-survivors.
- To determine if persistent severe hyperglycemia is an independent predictor of poor Glasgow Outcome Score (GOS).
- To evaluate different definitions and prevalence of poor GOS for improved measurement and treatment evaluation.
Main Methods:
- Retrospective cohort study at a Level I pediatric trauma center.
- Included children with moderate-to-severe TBI admitted to intensive care.
- Blood glucose levels were categorized (severe, moderate, mild hyperglycemia, normal glycemia, hypoglycemia) within the first 12 hours post-injury.
Main Results:
- Among 271 children, 20% experienced severe hyperglycemia (> 200 mg/dL).
- Dying children had higher mean blood glucose levels in the early post-injury period compared to survivors.
- Severe hyperglycemia was independently associated with a 3.5-fold increased odds of a poor outcome (adjusted OR, 1.2-10.3) compared to mild hyperglycemia.
Conclusions:
- Brief periods of severe hyperglycemia (blood glucose > 200 mg/dL) were independently associated with poor outcomes in pediatric TBI.
- Understanding hyperglycemia patterns is crucial for predicting outcomes and guiding treatment in pediatric neurocritical care.
Objective:
We sought 1) to describe the severity and duration of hyperglycemia among surviving and dying children after traumatic brain injury; 2) to evaluate whether persistent severe hyperglycemia (averaged blood glucose > 200 mg/dL [11 mmol/L] during the first 12 hr after injury) is independently associated with poor Glasgow Outcome Score; and 3) to evaluate different definitions and the prevalence of poor Glasgow Outcome Score to better understand measurement and potential hyperglycemia treatment evaluation.
Design:
Retrospective cohort.
Setting:
Level I American College of Surgery verified pediatric trauma center.
Patients:
Children admitted to intensive care with moderate-to-severe traumatic brain injury.
Interventions:
None.
Measurements And Main Results:
Time course for glucose changes was compared by survival and blood glucose groups. Twelve-hour averaged patient blood glucoses were categorized as persistent: severe hyperglycemia (> 200 mg/dL [11 mmol/L]), moderate hyperglycemia (161-200 mg/dL [9-11 mmol/L]), mild hyperglycemia (110-160 mg/dL [6-9 mmol/L]), normal glycemia (80-109 mg/dL [4-6 mmol/L]), or hypoglycemia (< 80 mg/dL [< 4 mmol/L]). Among 271 children, less than 1% had hypoglycemia and were excluded from further analysis. Seven percent had normal, 49% had mild, 24% had moderate, and 20% had severe blood glucose elevation. Among dying children (n = 44, 16%), the mean blood glucose at 20-24 hours after injury was significantly greater compared with survivors (150 vs 113 mg/dL [8 vs 6 mmol/L]) but by 29-32 hours, no longer significantly differed (112 vs 102 mg/dL [6 mmol/L]). Sixty-eight percent of children with severe blood glucose elevation had a poor outcome, whereas good outcomes at discharge occurred in 87% with mild or moderate blood glucose elevation. Severe blood glucose elevation was associated with a 3.5-fold increased adjusted odds ratio of poor outcome (95% CI, 1.2-10.3) compared with mild blood glucose elevation adjusted for injury severity and cardiorespiratory instability.
Conclusions:
Duration of severe blood glucose elevation (blood glucose > 200 mg/dL [11 mmol/L]) was brief but remained independently associated with poor outcome.
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