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Published on: May 27, 2022
Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
Talia D Baird1, Michael R Miller2,3, Saoirse Cameron2,3
1Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Insights
Nearly half of pediatric severe traumatic brain injury (sTBI) deaths in pediatric critical care units (PCCUs) involved withdrawal of life-sustaining therapies (WLST). Factors like higher partial thromboplastin time (PTT) and lower albumin were associated with mortality.
Area of Science:
- Pediatric Critical Care Medicine
- Neurotrauma Research
- Pediatric Mortality Studies
Background:
- Severe traumatic brain injury (sTBI) is a primary cause of mortality in children.
- Understanding the patterns and predictors of death in pediatric sTBI is crucial for improving outcomes.
Purpose of the Study:
- To determine the modes of death in children with sTBI admitted to a Pediatric Critical Care Unit (PCCU).
- To identify clinical and laboratory factors associated with mortality in this patient population.
Main Methods:
- Retrospective cohort study of pediatric patients (2000-2016) with sTBI (Glasgow Coma Scale ≤ 8, Maximum Abbreviated Injury Scale ≥ 4).
- Analysis included mode of death, clinical data, interventions, and laboratory values (early and pre-death).
Main Results:
- Of 195 sTBI patients, 55 (28%) died; 24 (44%) died due to withdrawal of life-sustaining therapies (WLST).
- Physiologic deaths (neurologic determination or cardiac arrest) occurred sooner than WLST deaths (median 35.2 vs. 79.5 hours).
- Higher partial thromboplastin time (PTT) within 24 hours and lower pre-death albumin levels were associated with the physiologic death group.
Conclusions:
- Withdrawal of life-sustaining therapies accounts for a significant proportion of pediatric sTBI deaths in PCCUs.
- Limited early and late factors were identified, with higher PTT and lower albumin showing some association with the mode of death.
Abstract:
Aims and Objectives: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Our aim was to determine the mode of death for children who died with sTBI in a Pediatric Critical Care Unit (PCCU) and evaluate factors associated with mortality. Methods: We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥ 12) with sTBI (Glasgow Coma Scale [GCS] ≤ 8 and Maximum Abbreviated Injury Scale ≥ 4) admitted to a Canadian PCCU (2000-2016). We analyzed mode of death, clinical factors, interventions, lab values within 24 h of admission (early) and pre-death (48 h prior to death), and reviewed meeting notes in patients who died in the PCCU. Results: Of 195 included patients with sTBI, 55 (28%) died in the PCCU. Of these, 31 (56%) had a physiologic death (neurologic determination of death or cardiac arrest), while 24 (44%) had withdrawal of life-sustaining therapies (WLST). Median (IQR) times to death were 35.2 (11.8, 86.4) hours in the physiologic group and 79.5 (17.6, 231.3) hours in the WLST group (p = 0.08). The physiologic group had higher partial thromboplastin time (PTT) within 24 h of admission (p = 0.04) and lower albumin prior to death (p = 0.04). Conclusions: Almost half of sTBI deaths in the PCCU were by WLST. There was a trend toward a longer time to death in these patients. We found few early and late (pre-death) factors associated with mode of death, namely higher PTT and lower albumin.
