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Hyperglycemia is not a poor prognostic sign in head-injured children
1Department of Pediatrics, University of Washington School of Medicine, Seattle.
Insights
Pediatric head injury can cause hyperglycemia, but it is transient and does not predict outcomes in children. This differs from adult trauma patients where hyperglycemia indicates a poor prognosis.
Area of Science:
- Pediatric critical care
- Neurotrauma
- Endocrinology
Background:
- Hyperglycemia in adult trauma patients, especially nonketotic hyperosmolar hyperglycemia, is linked to poor prognosis.
- Pediatric physiological responses to injury, particularly neurological, can differ significantly from adults.
Purpose of the Study:
- To characterize the hyperglycemic response in pediatric patients with closed head injury.
- To compare hyperglycemia incidence in pediatric head injury versus non-head injury cases.
- To determine if hyperglycemia predicts outcomes in children with severe head injury.
Main Methods:
- Retrospective study comparing pediatric patients (2-12 years) with closed head injury to a control group with non-head injury.
- Data collected over a 6-year period from a major regional trauma center.
- Analysis of hyperglycemic response and its association with patient outcomes.
Main Results:
- Hyperglycemic response was significantly more common in pediatric head injury patients (40%) than controls (5%) (p<0.001).
- Nonketotic hyperosmolar hyperglycemia was not observed in any pediatric patients.
- The level of hyperglycemia did not correlate with any indicators of patient outcome.
Conclusions:
- Hyperglycemia associated with pediatric closed head injury is typically transient.
- This pediatric hyperglycemia does not appear to require insulin therapy.
- Unlike in adults, hyperglycemia in children with severe head injury does not predict patient outcomes.
Abstract:
Hyperglycemia among adult trauma patients with head injuries is a recognized phenomenon which has been shown to be associated with a poor prognosis when it takes the form of nonketotic hyperosmolar hyperglycemia. It is not known to what extent a similar phenomenon occurs in pediatric patients, although it is known that a child's physiologic response to injury, particularly to neurologic injury, is often different than an adult's. This study was undertaken to characterize the hyperglycemic response of children with closed head injury compared to children with a non-head injury, and to measure the extent to which the presence of hyperglycemia is associated with a poor outcome among children with severe head injury. Records for all children ages 2 to 12 years admitted to a major regional trauma center with closed head injury over a 6-year period were compared to the records of a control group of children hospitalized for a non-head injury. The hyperglycemic response was more common among those with head trauma, occurring in 40% compared to 5% of the controls (p less than 0.001); however, the level of hyperglycemia could not be associated with any indicator of outcome. The entity known as nonketotic hyperosmolar hyperglycemia did not occur in any of these patients. Apparently, the hyperglycemia associated with closed head injury in children is transient, does not need to be treated with insulin therapy, and in contrast to what has been demonstrated in adult trauma patients, does not predict patient outcome.