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Association of initial assessment variables and mortality in severe pediatric traumatic brain injury
Katherine C Bergus1,2, Kelli N Patterson1,2, Lindsey Asti2
1Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Predicting mortality in pediatric severe traumatic brain injury (TBI) is crucial. Initial resuscitation data, including Glasgow Coma Scale (GCS) score and international normalized ratio (INR), significantly impacts in-hospital survival.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Clinical outcomes research
Background:
- Predictive scales for traumatic brain injury (TBI) outcomes exist, but predicting mortality from initial resuscitation data remains challenging.
- Severe TBI in pediatric patients requires effective prognostic tools to guide treatment and improve survival.
- Understanding the association between initial resuscitation variables and in-hospital mortality is vital for pediatric trauma care.
Purpose of the Study:
- To evaluate the association between clinical variables collected during initial resuscitation of intubated pediatric severe TBI patients and in-hospital mortality.
- To identify key resuscitation parameters that predict mortality in this vulnerable population.
- To inform the development of improved prognostic models for pediatric severe TBI.
Main Methods:
- A retrospective study included intubated pediatric trauma patients (<18 years) with severe TBI (Glasgow Coma Scale (GCS) score ≤8) from 2011-2020.
- Clinical variables assessed included temperature, pulse, mean arterial blood pressure, GCS score, hemoglobin, international normalized ratio (INR), platelet count, oxygen saturation, end tidal carbon dioxide, blood glucose, and pupillary response.
- Multivariable logistic regression was used to evaluate associations between resuscitation variables and in-hospital mortality.
Main Results:
- The study analyzed 314 pediatric patients with severe TBI; overall mortality was 26.8%.
- Significant predictors of in-hospital mortality included GCS score, Head Abbreviated Injury Score (hAIS), Injury Severity Score (ISS), INR, platelet count, and blood glucose.
- Higher GCS scores correlated with decreased mortality (35% odds reduction per point), while increased hAIS, INR (1427% odds increase per unit), and blood glucose correlated with increased mortality.
Conclusions:
- Pediatric patients with severe TBI face a high risk of in-hospital mortality.
- Initial resuscitation parameters, particularly INR and blood glucose levels, are strongly associated with mortality.
- Further research is needed to investigate the impact of early interventions targeting INR and blood glucose on mortality in pediatric severe TBI.
Background:
Predictive scales have been used to prognosticate long-term outcomes of traumatic brain injury (TBI), but gaps remain in predicting mortality using initial trauma resuscitation data. We sought to evaluate the association of clinical variables collected during the initial resuscitation of intubated pediatric severe patients with TBI with in-hospital mortality.
Methods:
Intubated pediatric trauma patients <18 years with severe TBI (Glasgow coma scale (GCS) score ≤8) from January 2011 to December 2020 were included. Associations between initial trauma resuscitation variables (temperature, pulse, mean arterial blood pressure, GCS score, hemoglobin, international normalized ratio (INR), platelet count, oxygen saturation, end tidal carbon dioxide, blood glucose and pupillary response) and mortality were evaluated with multivariable logistic regression.
Results:
Among 314 patients, median age was 5.5 years (interquartile range (IQR): 2.2-12.8), GCS score was 3 (IQR: 3-6), Head Abbreviated Injury Score (hAIS) was 4 (IQR: 3-5), and most had a severe (25-49) Injury Severity Score (ISS) (48.7%, 153/314). Overall mortality was 26.8%. GCS score, hAIS, ISS, INR, platelet count, and blood glucose were associated with in-hospital mortality (all p<0.05). As age and GCS score increased, the odds of mortality decreased. Each 1-point increase in GCS score was associated with a 35% decrease in odds of mortality. As hAIS, INR, and blood glucose increased, the odds of mortality increased. With each 1.0 unit increase in INR, the odds of mortality increased by 1427%.
Conclusions:
Pediatric patients with severe TBI are at substantial risk for in-hospital mortality. Studies are needed to examine whether earlier interventions targeting specific parameters of INR and blood glucose impact mortality.
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