Characterization and Prognostic Factors of Severe Pediatric Traumatic Brain Injury

Area of Science:

• Pediatric Critical Care Medicine
• Neurotrauma Research
• Public Health

Background:

• Traumatic brain injury (TBI) is a leading cause of death and long-term disability in children and young adults.
• Severe TBI in children presents significant challenges in pediatric intensive care units (PICUs), leading to neurological, functional, and behavioral sequelae.
• TBI is a critical public health issue with substantial societal impact.

Purpose of the Study:

• To characterize severe TBI patients admitted to a PICU over 15 years.
• To identify prognostic factors associated with mortality at PICU discharge for pediatric severe TBI cases.

Main Methods:

• An exploratory observational study with retrospective data collection was conducted.
• Data from children admitted with severe TBI to a Portuguese tertiary pediatric hospital PICU between 2010 and 2024 were analyzed.
• Demographic, clinical, and laboratory data were collected, with PICU discharge mortality as the primary outcome.

Main Results:

• Ninety-seven children with severe TBI were included, with pedestrian and motor vehicle accidents being common causes.
• Overall mortality was 21.6%. The Pediatric Index of Mortality 3 (PIM3) was the sole variable independently associated with mortality in multivariable analysis.
• Univariable analysis showed arterial hypotension and intracranial hypertension linked to mortality. Early Glasgow Coma Scale (GCS) (≤4), PIM3 (>64.3), lactate (>4 mmol/L), and fibrinogen (<158 mg/dL) showed discriminatory ability for mortality.

Conclusions:

• This study characterized severe TBI in a pediatric cohort, emphasizing the prognostic value of early clinical and laboratory indicators.
• While PIM3 was independently associated with mortality, GCS, lactate, and fibrinogen also showed significant associations in early assessments.
• Early identification of these factors may aid clinical decision-making, therapeutic interventions, and prognostication, warranting confirmation in multicenter studies.