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Prognostic implications of hyperglycaemia in paediatric head injury
A Chiaretti1, R De Benedictis, A Langer
1Paediatric Intensive Care Unit, Institute of Paediatrics, Catholic University, Rome, Italy.
Insights
High blood sugar after head injury (hyperglycaemia) is linked to worse outcomes in children. Persistent high blood sugar levels indicate a poor prognosis, emphasizing its role as a negative prognostic factor.
Area of Science:
- Pediatric Neurology
- Trauma Care
- Endocrinology
Background:
- Head injuries in children can lead to significant physiological stress.
- Understanding factors influencing long-term outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the correlation between post-traumatic hyperglycemia and long-term outcomes in pediatric head injury patients.
- To identify hyperglycemia as a potential prognostic indicator in pediatric head trauma.
Main Methods:
- Evaluation of 50 children with head injuries.
- Measurement of blood glucose levels on admission and subsequent days.
- Correlation analysis between blood glucose levels, Glasgow Coma Score (GCS), and Glasgow Outcome Score (GOS).
Main Results:
- Hyperglycemia was more frequent in severe head injuries (GCS ≤8), present in 87.5% of patients.
- Higher admission blood glucose levels correlated with poorer outcomes (GOS 1-3).
- Persistent hyperglycemia beyond 24 hours was observed in all non-survivors and those with poor outcomes.
Conclusions:
- Post-traumatic hyperglycemia is a significant negative prognostic factor in children with head injury.
- The persistence of hyperglycemia over time strongly indicates a poor long-term outcome.
- Monitoring blood glucose levels is essential for assessing prognosis in pediatric head trauma.
Abstract:
Fifty children with head injury were evaluated in an attempt to establish a correlation between post-traumatic hyperglycaemia and long-term outcome. In all the patients, the blood glucose level was measured on admission and on the days following the trauma (threshold of normal value set at 150 mg/dl). Hyperglycaemia was seen more frequently in children with severe head injury than in those with mild and moderate head injury. It was present in 87.5% of the patients with a Glasgow Coma Score (GCS) < or =8 (the average blood glucose level on admission was 237.8+/-92 mg/dl), in 60% of the patients with a GCS of 9-12 (178+/-78.7 mg/dl) and only in 25% of those with a GCS of 13-15 (131.5+/-39 mg/dl). A close correlation was also seen between the outcome and the blood glucose level. In fact, the blood glucose on admission was higher in the patients with a poor outcome, i.e. in those having a Glasgow Outcome Score (GOS) of 2 or 3 and in those who died (GOS 1), than in the patients with a good outcome (GOS of 4 or 5). Finally, hyperglycaemia persisted beyond the first 24 h after trauma in all the children who died or who survived with a poor outcome. Hyperglycaemia, and especially its persistence over time, appears to be an important negative prognostic factor in children with head injury.