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Observational Study
. 2023 Nov;165(11):3197-3206.
doi: 10.1007/s00701-023-05741-0. Epub 2023 Sep 20.

A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries-time to reappraise thresholds for treatment

Syeda Kashfi Qadri  1   2 , Jan Hau Lee  3   4 , Yanan Zhu  5 , Paula Caporal  6   7 , Juan D Roa G  8   9 , Sebastián González-Dambrauskas  10   11 , Adriana Yock-Corrales  12 , Qalab Abbas  13 , Yasser Kazzaz  14 , Luming Shi  5   15 , Dianna Sri Dewi  5 , Shu-Ling Chong  4   16 ; Pediatric Acute, Critical Care Medicine Asian Network (PACCMAN); Pediatric collaborative Latin American network (LARed)
Collaborators, Affiliations
Observational Study

A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries-time to reappraise thresholds for treatment

Syeda Kashfi Qadri et al. Acta Neurochir (Wien). 2023 Nov.

Abstract

Purpose: Children with moderate traumatic brain injury (modTBI) (Glasgow Coma Scale (GCS) 9-13) may benefit from better stratification. We aimed to compare neurocritical care utilization and functional outcomes between children with high GCS modTBI (hmodTBI, GCS 11-13), low GCS modTBI (lmodTBI, GCS 9-10), and severe TBI (sTBI, GCS ≤ 8). We hypothesized that patients with lmodTBI have higher neurocritical care needs and worse outcomes than patients with hmodTBI and are similar to patients with sTBI.

Methods: Prospective observational study from June 2018 to October 2022 in 28 pediatric intensive care units (PICU) in Asia, South America, and Europe. We included children (age < 18 years) with modTBI and sTBI admitted to PICU and measured functional outcomes at 3 months using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds, scale 1-8, 1 = upper good recovery, 8 = death).

Results: We analyzed 409 patients: 98 (24%) and 311 (76%) with modTBI and sTBI, respectively. Patients with lmodTBI (vs. hmodTBI) were more likely to have invasive ICP monitoring (32.3% vs. 4.5%, p < 0.001), longer PICU stay (days, median [IQR]; 5.00 [4.00, 9.75] vs 4.00 [2.00, 5.00], p = 0.007), and longer hospital stay (days, median [IQR]: 13.00 [8.00, 17.00] vs. 8.00 [5.00, 12, 25], p = 0.015). Median GOS-E Peds scores were significantly different (hmodTBI (1.00 [1.00, 3.00]), lmodTBI (3.00 [IQR 2.00, 5.75]), and sTBI (5.00 [IQR 1.00, 6.00]) (p < 0.001)). After adjusting for age, sex, presence of polytrauma and cerebral edema, lmodTBI, and sTBI remained significantly associated with higher GOS-E scores (adjusted coefficient (standard error): 1.24 (0.52), p = 0.018, and 1.27 (0.33), p < 0.001, respectively) compared with hmodTBI.

Conclusions: Children with lmodTBI have higher rates of neurocritical care utilization and worse functional outcomes than those with hmodTBI but better than those with sTBI. Children with lmodTBI may benefit from guideline-based management similar to what is implemented in children with sTBI. This work was performed in hospitals within the PACCMAN and LARed networks. No reprints will be ordered.

Keywords: Adolescent; Child; Glasgow Coma Scale; Infant; Traumatic brain injury; Treatment outcome.

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References

    1. About PACCMAN. https://www.scri.edu.sg/crn/pediatric-acute-critical-care-medicine-asian... . Accessed 31 Oct 2022
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