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Neurocritical factors associated with mortality and functional recovery in pediatric trauma patients admitted to a
Beyza Nur Mert Bakal1,2, Selman Kesici3,4, Izzet Turkalp Akbasli2,5
1Başakşehir Çam And Sakura City Hospital, Başakşehir, Istanbul, 34480, Türkiye.
Insights
Early neurological compromise and systemic instability in pediatric trauma patients predict mortality and functional outcomes. Identifying these factors aids in risk stratification and timely care escalation for better neuroprognosis.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Trauma surgery outcomes
Background:
- Pediatric trauma patients admitted to the Pediatric Intensive Care Unit (PICU) require identification of early neuroprognostic factors.
- Predicting functional neurological outcome is crucial for guiding treatment and resource allocation.
Purpose of the Study:
- To identify early neuroprognostic factors associated with functional neurological outcome in pediatric trauma patients.
- To assess factors related to in-hospital mortality and brain death in this population.
Main Methods:
- Retrospective cohort study of 425 pediatric trauma admissions to a tertiary PICU.
- Analysis of demographics, injury mechanisms, severity scores (GCS, PRISM III, PTS), CT findings, laboratory markers, and interventions.
- Multivariable logistic regression and receiver operating characteristic analyses were used to assess factors associated with mortality.
Main Results:
- Overall mortality was 7.3%, predominantly from severe traumatic brain injury. 82.1% had good neurological outcome (GOS 4-5) at discharge.
- Poor outcome was associated with low admission Glasgow Coma Scale (GCS), cerebral edema, hyperglycemia, and elevated lactate.
- Factors independently associated with mortality included inotropic support, blood product administration, albumin administration, cerebral edema, and admission GCS ≤ 8.
Conclusions:
- Early neurological compromise and systemic instability are key predictors of mortality and functional recovery in critically injured children.
- Neurofocused risk stratification and timely escalation of care are supported by these findings.
- These factors are identifiable during initial stabilization, aiding in early prognostication.
Purpose:
To identify early neuroprognostic factors associated with functional neurological outcome in pediatric trauma patients requiring PICU admission. The primary outcome was Glasgow Outcome Scale (GOS) at discharge and 6 months; secondary outcomes were in-hospital mortality and brain death.
Methods:
We conducted a retrospective cohort study of 425 consecutive pediatric trauma admissions to a tertiary PICU from June 2014 to December 2021. Demographics, mechanisms of injury, admission severity scores (GCS, PRISM III, PTS), cranial CT findings, early laboratory markers, and key interventions were analyzed. Factors independently associated with mortality were assessed using multivariable logistic regression, and discrimination was evaluated with receiver operating characteristic analyses.
Results:
Median age was 78 months and 64.2% were male. Falls and traffic accidents were the most common mechanisms. Overall mortality was 7.3% and was predominantly attributable to severe traumatic brain injury (29 of 31 deaths). Brain death occurred in 4.5%. At discharge, 349 of 425 patients (82.1%) had a good neurological outcome (GOS 4-5), whereas 76 (17.9%) had a poor outcome (GOS 1-3), including 31 in-hospital deaths (GOS 1). Among 394 hospital survivors, 6-month follow-up was available for 377 (95.7%); of these, 364 (96.6%) achieved good recovery and 13 (3.4%) had persistent poor outcomes. Among survivors with a poor outcome at discharge and available follow-up, 25 of 38 (65.8%) improved to a good outcome by six months. Seventeen survivors were lost to follow-up. Poor outcome (GOS 1 to 3) was associated with low admission GCS, cerebral edema or midline shift, and early physiologic stress including hyperglycemia and elevated lactate. Factors independently associated with mortality were inotropic support (OR 6.98), blood product administration (OR 6.52), albumin administration (OR 3.69), cerebral edema (OR 3.59), and admission GCS 8 or less (OR 6.82). PRISM III and PTS showed strong discrimination.
Conclusion:
In critically injured children, early neurological compromise and systemic instability that are identifiable during initial stabilization were the strongest factors associated with mortality and functional recovery, supporting neurofocused risk stratification and timely escalation of care.
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