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Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay.

Chong SL, Harjanto S, Testoni D, Ng ZM, Low CY, Lee KP, Lee JH - Int J Endocrinol (2015)

Bottom Line: Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days.This association was however not significant in the stratified analysis of patients with GCS ≤ 8.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899 ; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, 100 Bukit Timah Road, Singapore 229899.

ABSTRACT
We aim to study the association between hyperglycemia and in-hospital outcomes among children with moderate and severe traumatic brain injury (TBI). This retrospective cohort study was conducted in a tertiary pediatric hospital between 2003 and 2013. All patients < 16 years old who presented to the Emergency Department within 24 hours of head injury with a Glasgow Coma Scale (GCS) ≤ 13 were included. Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days. Hyperglycemia was defined as glucose > 200 mg/dL (11.1 mmol/L). Among the 44 patients analyzed, the median age was 8.6 years (interquartile range (IQR) 5.0-11.0). Median GCS and pediatric trauma scores were 7 (IQR 4-10) and 4 (IQR 3-6), respectively. Initial hyperglycemia was associated with death (37% in the hyperglycemia group versus 8% in the normoglycemia group, p = 0.019), reduced median PICU-free days (6 days versus 11 days, p = 0.006), and reduced median ventilation-free days (8 days versus 12 days, p = 0.008). This association was however not significant in the stratified analysis of patients with GCS ≤ 8. Conclusion. Our findings demonstrate that early hyperglycemia is associated with increased mortality, prolonged duration of mechanical ventilation, and PICU stay in children with TBI.

No MeSH data available.


Related in: MedlinePlus

Flow chart of cohort of children with moderate to severe traumatic brain injury.
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Related In: Results  -  Collection


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fig1: Flow chart of cohort of children with moderate to severe traumatic brain injury.

Mentions: Out of a total of 59 patients who matched the inclusion criteria, three were excluded because of prior care in other institutions and had a delayed transfer of >24 hours to our hospital. Five were found to have drowsiness attributed to causes other than the head injury and seven patients had incomplete data; they did not have glucose measurements in the ED or during the PICU stay (Figure 1). Of the 44 patients with complete data, the median age was 8.6 years (IQR 5.0–11.0), with a median GCS of 7 (IQR 4–10) and a median PTS of 4 (IQR 3–6) (Table 1). Three patients who were transferred from other local institutions had a median delay of 5 hours between the time of injury and time of arrival in our center. The most common mechanism of injury was by motor vehicle accidents (22 patients, 50.0%). 21 (47.7%) patients had polytrauma. The overall mortality was 9/44 (20.5%). There were 16 patients (36.4%) who sustained skull and base of skull fractures, 36 (81.8%) with focal intracranial bleeds (not exclusive: SDH (16, 44.4%), EDH (13, 36.1%), SAH (8, 22.2%), and intraparenchymal bleed (8, 22.2%). 20 (45.5%) patients had cerebral edema and 7 (15.9%) had diffuse axonal injury.


Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay.

Chong SL, Harjanto S, Testoni D, Ng ZM, Low CY, Lee KP, Lee JH - Int J Endocrinol (2015)

Flow chart of cohort of children with moderate to severe traumatic brain injury.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446478&req=5

fig1: Flow chart of cohort of children with moderate to severe traumatic brain injury.
Mentions: Out of a total of 59 patients who matched the inclusion criteria, three were excluded because of prior care in other institutions and had a delayed transfer of >24 hours to our hospital. Five were found to have drowsiness attributed to causes other than the head injury and seven patients had incomplete data; they did not have glucose measurements in the ED or during the PICU stay (Figure 1). Of the 44 patients with complete data, the median age was 8.6 years (IQR 5.0–11.0), with a median GCS of 7 (IQR 4–10) and a median PTS of 4 (IQR 3–6) (Table 1). Three patients who were transferred from other local institutions had a median delay of 5 hours between the time of injury and time of arrival in our center. The most common mechanism of injury was by motor vehicle accidents (22 patients, 50.0%). 21 (47.7%) patients had polytrauma. The overall mortality was 9/44 (20.5%). There were 16 patients (36.4%) who sustained skull and base of skull fractures, 36 (81.8%) with focal intracranial bleeds (not exclusive: SDH (16, 44.4%), EDH (13, 36.1%), SAH (8, 22.2%), and intraparenchymal bleed (8, 22.2%). 20 (45.5%) patients had cerebral edema and 7 (15.9%) had diffuse axonal injury.

Bottom Line: Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days.This association was however not significant in the stratified analysis of patients with GCS ≤ 8.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899 ; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, 100 Bukit Timah Road, Singapore 229899.

ABSTRACT
We aim to study the association between hyperglycemia and in-hospital outcomes among children with moderate and severe traumatic brain injury (TBI). This retrospective cohort study was conducted in a tertiary pediatric hospital between 2003 and 2013. All patients < 16 years old who presented to the Emergency Department within 24 hours of head injury with a Glasgow Coma Scale (GCS) ≤ 13 were included. Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days. Hyperglycemia was defined as glucose > 200 mg/dL (11.1 mmol/L). Among the 44 patients analyzed, the median age was 8.6 years (interquartile range (IQR) 5.0-11.0). Median GCS and pediatric trauma scores were 7 (IQR 4-10) and 4 (IQR 3-6), respectively. Initial hyperglycemia was associated with death (37% in the hyperglycemia group versus 8% in the normoglycemia group, p = 0.019), reduced median PICU-free days (6 days versus 11 days, p = 0.006), and reduced median ventilation-free days (8 days versus 12 days, p = 0.008). This association was however not significant in the stratified analysis of patients with GCS ≤ 8. Conclusion. Our findings demonstrate that early hyperglycemia is associated with increased mortality, prolonged duration of mechanical ventilation, and PICU stay in children with TBI.

No MeSH data available.


Related in: MedlinePlus