Related Experiment Video
Updated: Jul 25, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Time spent with impaired autoregulation is linked with outcome in severe infant/paediatric traumatic brain injury
Konstantin Hockel1, Jennifer Diedler2, Felix Neunhoeffer3
1Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany. Konstantin.hockel@med.uni-tuebingen.de.
Insights
Impaired cerebrovascular autoregulation (AR) in children with severe traumatic brain injury (TBI) is linked to poor outcomes. Prolonged periods of disrupted AR, especially in infants, indicate a worse prognosis. Maintaining optimal cerebral perfusion pressure is crucial for favorable recovery.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Trauma Surgery
Background:
- Cerebrovascular autoregulation (AR) and its predictive value for outcomes in adult traumatic brain injury (TBI) are established.
- The role of AR, specifically the pressure reactivity index (PRx), cerebral perfusion pressure (CPP), and intracranial pressure (ICP), in severe pediatric TBI requires further investigation.
Purpose of the Study:
- To investigate the correlation between PRx, CPP, ICP, and patient outcomes in severe infant and pediatric TBI.
- To determine if AR status predicts outcomes in pediatric TBI.
Main Methods:
- Seventeen pediatric patients (1 day–14 years) with severe TBI underwent continuous ICP and mean arterial pressure monitoring.
- Software was used to determine CPP, PRx, and optimal CPP. Outcome was assessed using the Glasgow Outcome Scale at discharge and follow-up.
Main Results:
- While overall ICP, CPP, and PRx did not significantly differ between favorable and unfavorable outcomes, the duration of severely impaired AR (PRx > 0.2) was significantly longer in patients with unfavorable outcomes (64 hours vs. 6 hours).
- Continuously impaired AR for ≥24 hours and age < 1 year were associated with unfavorable outcomes.
- Patients with favorable outcomes consistently maintained CPP at or above the optimal level.
Conclusions:
- Cerebrovascular autoregulation integrity plays a critical role in TBI outcomes in pediatric patients, similar to adults.
- The duration of impaired AR is a significant factor associated with outcomes, particularly in infants.
- Further validation of these preliminary findings in larger studies is warranted.
Background:
It could be shown in traumatic brain injury (TBI) in adults that the functional status of cerebrovascular autoregulation (AR), determined by the pressure reactivity index (PRx), correlates to and even predicts outcome. We investigated PRx, cerebral perfusion pressure (CPP) and intracranial pressure (ICP) and their correlation to outcome in severe infant and paediatric TBI.
Methods:
Seventeen patients (range, 1 day to 14 years) with severe TBI (median GCS at presentation, 4) underwent long-term computerised ICP and mean arterial pressure (MAP) monitoring using dedicated software to determine CPP and PRx and optimal CPP (CPP level where PRx shows best autoregulation) continuously. Outcome was determined at discharge and at follow-up using the Glasgow Outcome Scale.
Results:
Favourable outcome was reached in eight patients, unfavourable outcome in seven patients. Two patients died. Nine patients underwent decompressive craniectomy to control ICP during Intensive Care Unit treatment. When dichotomised to outcome, no significant difference was found for overall ICP, CPP and PRx. The time with severely impaired AR (PRx >0.2) was significantly longer for patients with unfavourable outcome (64 h vs 6 h, p = 0.001). Continuously impaired AR of ≥24 h and age <1 year was associated to unfavourable outcome. Children with favourable outcome spent the entire monitoring time at or above the optimal CPP.
Conclusions:
Integrity of AR has a similar role for outcome after TBI in the paediatric population as in adults. The amount of time spent with deranged AR seems to be associated with outcome; a factor especially critical for infant patients. The results of this preliminary study need to be validated in the future.
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
01:29Increased Intracranial Pressure ll: Pathophysiology