Frequency and Indications for Anesthesia Exposure in a Pediatric Traumatic Brain Injury Cohort

Pediatric traumatic brain injury (pTBI) is a leading cause of morbidity in the pediatric population. These patients often undergo multiple anesthetic exposures (AE) during hospitalization for their injuries. In this retrospective study, we sought to analyze the hospital course and outcomes in pTBI patients, hypothesizing that these patients required multiple AEs and that repeated AEs increased the risk for morbidity.

A chart review of pTBI patients from the Westchester Medical Center Pediatric Trauma Registry was conducted from 2012 to 2021. Demographics, injury data, and hospital course were extracted. Patients were grouped based on the number of AEs, and the hospital course was compared between the groups. Outcomes studied included indications for AE, infection rate, discharge disposition, and new morbidity.

Three hundred and five patients were admitted within the studied period. Increasing AE was associated with worse Injury Severity Scores (ISS) and lower Glasgow Coma Scale (GCS) scores (p < 0.001), as well as with higher rates of intubation, intensive care unit (ICU) admission, external ventricular drain placement, intracranial pressure (ICP) monitor placement, seizure rates, prolonged hospital length of stay (LOS), and decreased likelihood to be discharged home (p < 0.001). On multivariate analysis, AE was associated with infection (p < 0.001) and new morbidity (p = 0.020).

In a cohort of pTBI patients, our review confirmed high anesthesia resource utilization and an increased risk of hospital-acquired infections and new morbidity in patients undergoing multiple anesthetic exposures. Future controlled trials are needed to evaluate the effects and better understand the risk-benefit ratio of multiple procedures and AEs in pTBI patients.