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Predicting inpatient mortality in pediatric traumatic brain injury: insights from a national database
Enrique G Villarreal1, Riddhi D Patel2, Juan S Farias3
1Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico. quique_villarreal93@hotmail.com.
Insights
Traumatic brain injury (TBI) in the pediatric intensive care unit (PICU) has an 18.5% mortality risk, often linked to organ dysfunction. A new TBI mortality risk score can help identify high-risk pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Clinical outcomes analysis
Background:
- Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children.
- Identifying factors associated with outcomes in the pediatric intensive care unit (PICU) is crucial for improving patient care.
- Previous research has focused on general TBI outcomes, but specific PICU admission factors require further investigation.
Purpose of the Study:
- To determine factors associated with mortality and length of stay (LOS) in pediatric intensive care unit (PICU) admissions for traumatic brain injury (TBI).
- To develop a practical risk score for predicting mortality in pediatric TBI patients.
Main Methods:
- Retrospective cohort study of 3041 PICU admissions with TBI across 49 US hospitals (2016-2021) using the Pediatric Health Information System database.
- Univariable analyses compared mortality groups.
- Multivariable logistic and linear regression analyses identified predictors of mortality and LOS, including a subgroup analysis for patients with cerebral edema and survivors.
Main Results:
- Inpatient mortality was 18.5%, with younger patients and lower pediatric Glasgow Coma Scale scores being significant risk factors.
- Multisystem organ dysfunction, including acute renal, hepatic, and respiratory failure, along with acidosis and cardiac arrest, were associated with increased mortality.
- The developed TBI mortality risk score demonstrated high accuracy (AUC 0.89) in predicting mortality, with a score of 6 or higher indicating an 88% mortality risk.
Conclusions:
- Pediatric TBI admissions to the PICU carry a substantial mortality risk, particularly within the first 48 hours.
- Greater multisystem organ dysfunction and need for medical/mechanical support characterize patients with fatal outcomes.
- The proposed TBI mortality risk score is a valuable tool for early identification of high-risk pediatric TBI patients, facilitating timely intervention.
Purpose:
The purpose of this study was to determine factors significantly associated with mortality and length of stay (LOS) in admissions to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI).
Methods:
A cross-sectional, retrospective cohort study that identified PICU admissions with TBI from forty-nine hospitals in the USA using the Pediatric Health Information System database from 2016 to 2021. Univariable analyses comparing those who did and did not experience mortality were performed. The following regression analyses were conducted: logistic regression with mortality as dependent variable; linear regression with LOS as the dependent variable; logistic regression with mortality as the dependent variable but only included patients with cerebral edema; and linear regression with LOS as the dependent variable but only included patients who survived. From the regression analysis for mortality in all TBI patients was utilized to develop a mortality risk score.
Results:
A total of 3041 admissions were included. Those with inpatient mortality (18.5%) tended to be significantly younger (54 vs. 92 months, p < 0.01), have < 9 pediatric Glasgow Coma Scale on admission (100% vs. 52.9%, p < 0.01) and more likely to experience acute renal, hepatic and respiratory failure, acidosis, central diabetes insipidus, hyperkalemia, and hypocalcemia. Regression analysis identified that pediatric Glasgow Coma Scale, alkalosis and cardiac arrest significantly increased risks of mortality. The TBI mortality risk score had an area under the curve of 0.89 to identify those with mortality; a score of 6 ≤ was associated with 88% mortality.
Conclusion:
Patients admitted to the PICU with TBI have 18.5% risk of inpatient mortality with most occurring the first 48 h and these are characterized with greater multisystem organ dysfunction, received medical and mechanical support. TBI mortality risk score suggested is a practical tool to identify patients with an increase likelihood to die.
