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Gastrointestinal failure score in children with traumatic brain injury
Ying Zhou1, Weifeng Lu1, Weibing Tang2
1Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Jiangsu Province, 210008, Nanjing, China.
Insights
The gastrointestinal failure (GIF) score effectively predicts mortality in pediatric traumatic brain injury (TBI) patients. Early assessment of gastrointestinal function using the GIF score in the ICU improves patient outcome prediction.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Gastroenterology
Background:
- Traumatic brain injury (TBI) in children often leads to gastrointestinal complications.
- Assessing gastrointestinal function is crucial for managing pediatric TBI patients.
Purpose of the Study:
- To evaluate the prognostic value of the gastrointestinal failure (GIF) score in pediatric TBI patients.
- To analyze the correlation between gastrointestinal function and patient outcomes.
Main Methods:
- Retrospective analysis of 165 pediatric TBI patients admitted to the surgical intensive care unit (SICU).
- Collected demographic and clinical data, including Glasgow Coma Scale (GCS) and various laboratory markers.
- Utilized the GIF score, Pediatric Clinical Illness Score (PCIS), and Pediatric Sequential Organ Failure Assessment (SOFA) score for outcome prediction.
Main Results:
- High incidence of gastrointestinal dysfunction (78.8%) and complications like food intolerance (36.4%) and intra-abdominal hypertension (21.8%) observed.
- The GIF score and its 3-day mean were significantly associated with TBI severity and mortality.
- The mean GIF score over the first three days independently predicted ICU mortality, comparable to the PCIS.
Conclusions:
- Gastrointestinal dysfunction is common in pediatric TBI.
- The GIF score is a valuable tool for assessing gastrointestinal status in these patients.
- The mean GIF score in the initial three ICU days demonstrates significant prognostic capability for mortality.
Background:
To review the value of the gastrointestinal failure (GIF) score in children with different degrees of traumatic brain injury (TBI) by analyzing the correlation between outcome and gastrointestinal function.
Methods:
A total of 165 children with TBI who were diagnosed and treated in the surgical intensive care unit (SICU) for longer than 72 h between August 2017 and September 2019 were analyzed. Admission parameters included sex, age, Glasgow Coma Scale (GCS) score, body mass index (BMI), leukocyte count, C-reactive protein (CRP), hemoglobin (Hb), hematocrit (Hct), blood glucose, lactic acid, procalcitonin (PCT), albumin, plasma osmotic pressure, prothrombin time (PT) and activated partial thromboplastin time (APTT). To predict outcomes, the Pediatric Sequential Organ Failure Assessment (SOFA) score, Pediatric Clinical Illness Score (PCIS), and mean GIF score for the first three days were combined.
Results:
The percentage of patients with gastrointestinal dysfunction on the first day was 78.8 %. Food intolerance (FI) and intra-abdominal hypertension (IAH) developed in 36.4 and 21.8 % of the patients, respectively. The GIF score and mean GIF score for the first three days were significantly different between children with different degrees of TBI (P < 0.05); these scores were also significantly different between patients who died and those who survived (P < 0.05). The mean GIF score for the first three days was identified as an independent risk factor for mortality (odds ratio > 1, 95 % confidence interval = 1.457 to 16.016, P < 0.01), as was the PCIS. Receiver operating characteristic (ROC) curve analysis suggested that the mean GIF score for the first three days had the same calibrating power as the PCIS in discriminating the risk of death of children.
Conclusions:
The incidence of gastrointestinal dysfunction in children with TBI is high. The GIF score has the ability to reflect the status of the gastrointestinal system. The mean GIF score for the first three days has high prognostic value for ICU mortality in the SICU.
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