Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury

Bedda L. Rosario, Christopher M. Horvat, Stephen R. Wisniewski, Michael J. Bell, Ashok Panigrahy, Giulio Zuccoli, Srikala Narayanan, Goundappa K. Balasubramani, Sue R. Beers, P. David Adelson
2018 Pediatric Critical Care Medicine  
Objective-To identify injury patterns and characteristics associated with severe traumatic brain injury (TBI) course and outcome, within a well-characterized cohort, which may help guide new research and treatment initiatives. Design-A secondary analysis of a phase 3, randomized, controlled trial that compared therapeutic hypothermia versus normothermia following severe TBI in children. Setting-Fifteen sites in the United States, Australia and New Zealand. Patients-Children (<18 years old) with
more » ... severe TBI. (n=77) were examined for association with mortality and outcome, as measured by the Glasgow Outcome Scale-Extended Pediatrics (GOS-E Peds) 3 months after TBI. Data are presented as odds ratios with 95% confidence intervals (OR [95% CI]). No demographic, clinical or CT characteristic was associated with mortality in bivariate analysis. Characteristics associated with worse GOS-E Peds in bivariate analysis were two fixed pupils (14.17 [3.38-59.37]), abdominal abbreviated injury severity (AIS) score (2.03 [1.19-3.49]), and subarachnoid hemorrhage (3.36 [1.30-8.70]). Forward stepwise regression demonstrated that AIS spine (3.48 [1.14-10.58]) and midline shift on CT (8.35 [1.05-66.59]) were significantly associated with mortality. Number of fixed pupils (one fixed pupil 3.47 [0.79-15.30]; two fixed pupils 13.61 [2.89-64.07]), hypoxia (5.22 [1.02-26.67]) and subarachnoid hemorrhage (3.01 [1.01-9 .01]) were independently associated with worse GOS-E Peds following forward stepwise regression. Measurements and Main Results-Baseline, clinical and computed tomography (CT) characteristics of patients Conclusions-Severe traumatic brain injury (TBI) is a clinically heterogeneous disease that can be accompanied by a range of neurologic impairment and a variety of injury patterns at presentation. This secondary analysis of prospectively collected data identifies several characteristics associated with outcome among children with severe TBI. Future, larger trials are needed to better characterize phenotypes within this population.
doi:10.1097/pcc.0000000000001676 pmid:30067578 pmcid:PMC6170689 fatcat:rs3nc7vj4bc37nvq4wlmdx33q4