Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma

Abstract

Purpose: The objective of this study was to determine the morbidity associated with hypotension in the resuscitative phase of pediatric head trauma.

Methods: A retrospective review (1990 to 1995) was performed at a level-1 pediatric trauma facility. Inclusion criteria included a Glasgow coma score (GCS) of 6 to 8 and absence of penetrating trauma or bleeding disorders. The GCS was assigned using a postresuscitation examination by a neurosurgeon. Hypotension was defined as a blood pressure reading of less than the fifth percentile for age that lasted longer than 5 minutes. Episodes were monitored from the onset of injury through the first 24 hours of hospitalization. Glasgow outcome scale (GOS) was assigned based on a 3-month follow-up evaluation. Analysis of variance (ANOVA) and contingency table analysis were performed on all groups, and a P value of less than .05 was taken to represent statistical significance.

Results: Seventy-two patients met inclusion criteria. They had a mean GCS of 7.2 and a mean age of 6 years; 97% survived. Early hypotension was associated with worse neurological outcome (GOS) and prolonged hospitalization. There was no significant correlation between GOS and age, gender, injury mechanism, associated injuries, or transport time.

Conclusions: These data suggest that maintaining adequate blood pressure during the early resuscitation of pediatric blunt head trauma patients may improve neurological outcome.