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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

Glucose levels for survivors versus nonsurvivors over time. The points signify the median glucose levels and the shaded area signifies the interquartile range.
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fig2: Glucose levels for survivors versus nonsurvivors over time. The points signify the median glucose levels and the shaded area signifies the interquartile range.

Mentions: The median glucose in ED was 180.0 mg/dL {10 mmol/L} (IQR 131.4–257.4 mg/dL {7.3–14.3 mmol/L}). Two patients died in the ED. Both patients arrived with a GCS of 3 and had hypoglycemia on arrival (45 mg/dL {2.5 mmol/L} and 18 mg/dL {1 mmol/L}). Among the 42 patients who survived to admission, only five patients (11.9%) received insulin infusion at 0–24 hours of admission, and four of these (9.5%) continued to receive insulin infusion at 24–48 hours of hospitalization. Fourteen of our patients (31.8%) received inotropes. These consisted of dopamine, adrenaline, and noradrenaline, in varying combinations. The other 7 deaths occurred between the 3rd and 10th day of stay in the PICU. The separation of glucose levels between survivors and nonsurvivors was most marked at about 24 hours after arrival in the ED (Figure 2). Only 27 patients (61.4%) had documented lactate levels (in the first 24 hours after arrival) because blood lactate was instituted only after the starting date of this retrospective study. The median peak level of lactate in the first 24 hours among these 27 patients was 2.6 mmol/L (IQR 1.7–4.8 mmol/L).


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)

Glucose levels for survivors versus nonsurvivors over time. The points signify the median glucose levels and the shaded area signifies the interquartile range.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Glucose levels for survivors versus nonsurvivors over time. The points signify the median glucose levels and the shaded area signifies the interquartile range.
Mentions: The median glucose in ED was 180.0 mg/dL {10 mmol/L} (IQR 131.4–257.4 mg/dL {7.3–14.3 mmol/L}). Two patients died in the ED. Both patients arrived with a GCS of 3 and had hypoglycemia on arrival (45 mg/dL {2.5 mmol/L} and 18 mg/dL {1 mmol/L}). Among the 42 patients who survived to admission, only five patients (11.9%) received insulin infusion at 0–24 hours of admission, and four of these (9.5%) continued to receive insulin infusion at 24–48 hours of hospitalization. Fourteen of our patients (31.8%) received inotropes. These consisted of dopamine, adrenaline, and noradrenaline, in varying combinations. The other 7 deaths occurred between the 3rd and 10th day of stay in the PICU. The separation of glucose levels between survivors and nonsurvivors was most marked at about 24 hours after arrival in the ED (Figure 2). Only 27 patients (61.4%) had documented lactate levels (in the first 24 hours after arrival) because blood lactate was instituted only after the starting date of this retrospective study. The median peak level of lactate in the first 24 hours among these 27 patients was 2.6 mmol/L (IQR 1.7–4.8 mmol/L).

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