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The impact of early hyperglycaemia on children with traumatic brain injury
Yue-Qiang Fu1, Shu-Ling Chong2,3, Jan Hau Lee3,4
1a Department of Critical Care Medicine, Children's Hospital , Chongqing Medical University , Chongqing , China.
Insights
Early high blood sugar (hyperglycaemia) in children with traumatic brain injury (TBI) is linked to worse outcomes. This includes higher mortality and fewer free days from ventilation, PICU, and hospital stays.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Metabolic disorders in critical illness
Background:
- Hyperglycemia is a frequent complication in pediatric patients suffering from traumatic brain injury (TBI).
- The clinical significance of early hyperglycemia in this vulnerable population remains an area of active investigation.
Purpose of the Study:
- To investigate the association between early hyperglycemia and adverse clinical outcomes in children with moderate to severe TBI.
- To identify hyperglycemia as a potential predictor of mortality and prolonged hospital stay in pediatric TBI.
Main Methods:
- Retrospective study of pediatric patients (<16 years) with TBI and Glasgow Coma Scale (GCS) ≤13.
- Hyperglycemia defined as glucose >11.1 mmol/L.
- Primary outcome: mortality. Secondary outcomes: ventilation-free, PICU-free, and hospital-free days.
Main Results:
- Initial hyperglycemia was a significant risk factor for in-hospital mortality (OR: 15.23, P < 0.001).
- Lower GCS (≤8) also predicted mortality (OR: 13.02, P = 0.004).
- Early hyperglycemia was associated with reduced ventilation-free, PICU-free, and hospital-free days.
Conclusions:
- Early hyperglycemia is a strong predictor of in-hospital mortality in children with moderate to severe TBI.
- Hyperglycemia is also associated with poorer recovery, indicated by fewer days free from critical care interventions and hospitalization.
Objective:
Hyperglycaemia is common amongst children with traumatic brain injury (TBI). We aim to investigate the association between early hyperglycaemia and poor clinical outcomes in children with moderate to severe TBI.
Methods:
We performed a retrospective study in a tertiary paediatric hospital between May 2012 and October 2014 of all patients with TBI who were aged <16 years with a Glasgow Coma Scale (GCS) of ≤13. The primary outcome was death. Secondary outcomes were 14 ventilation-free, 14 paediatric intensive care unit (PICU)-free and 28 hospital-free days. We defined hyperglycaemia as glucose >11.1 mmol/L (200 mg/dL).
Results:
There were 109 patients with a median age of 54 months [inter-quartile range (IQR): 17-82]. Median glucose on arrival was 6.1 mmol/L (IQR: 5.2-9.8). Median GCS in our cohort was 8 (IQR: 6-12). Multivariate logistic regression demonstrated that initial hyperglycaemia [odds ratio (OR): 15.23; 95% confidence interval (CI): 3.74-62.00; P < 0.001], and GCS <8 (OR: 13.02; 95% CI: 2.31-73.33; P = 0.004) were risk factors for mortality. Multivariate linear regression showed that initial hyperglycaemia was a risk factor for reduced ventilation-free, PICU-free and hospital-free days.
Conclusions:
Early hyperglycaemia predicts for in-hospital mortality, reduced ventilation-free, PICU-free and hospital-free days in children with moderate to severe TBI.
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