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Updated: Aug 1, 2025

Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
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Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury

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Procalcitonin and Pediatric Traumatic Brain Injury: Differentiating Neuro-storming From Infection.

Dimitra Lotakis1, Jack Vernamonti1, Peter Ehrlich1

  • 1Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.

The Journal of Surgical Research
|April 27, 2023
PubMed
Summary

In pediatric traumatic brain injury (TBI) patients, recurrent fevers are common. Procalcitonin (PCT) did not help distinguish infection from neuro-storming in this study.

Keywords:
Intensive careProcalcitoninSepsisTraumaTraumatic brain injury

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Area of Science:

  • Pediatric critical care medicine
  • Neuroscience
  • Infectious disease diagnostics

Background:

  • Recurrent fevers in pediatric traumatic brain injury (TBI) pose diagnostic challenges, potentially indicating infection or sterile neuro-storming.
  • Procalcitonin (PCT) is a biomarker for pediatric sepsis, but its utility in TBI patients is not well-established.

Purpose of the Study:

  • To investigate if Procalcitonin (PCT) can differentiate between sepsis and neuro-storming in pediatric patients with moderate-to-severe TBI.
  • To identify predictors of bacterial infection in this vulnerable population.

Main Methods:

  • Retrospective review of pediatric patients (0-18 years) with moderate-to-severe TBI admitted to the ICU.
  • Inclusion criteria: recurrent febrile episodes, infectious evaluation including cultures and PCT within 48 hours of fever.
  • Univariate and multivariate analyses to assess correlations between PCT, temperature, and positive bacterial cultures.

Main Results:

  • Eighty-five percent of TBI patients experienced recurrent fevers; 28% met inclusion criteria for analysis.
  • Culture-positive workups occurred in 66% of included infectious evaluations.
  • Median PCT levels did not differ between culture-positive and negative workups (P=0.94).
  • Neither PCT nor temperature correlated with positive bacterial cultures in multivariate analysis.

Conclusions:

  • In this pilot study, PCT did not correlate with sepsis or neuro-storming in pediatric TBI patients with recurrent fevers.
  • Further prospective research is needed to establish PCT's role and identify reliable sepsis predictors in pediatric TBI.