Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury
Background Pediatric traumatic brain injury (TBI) has distinctive pathophysiology and characteristics that differ from adults. These can be attributed to age-related anatomical and physiological differences and distinct patterns of injuries seen in children. Our aim was to identify the patient chara...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical and Scientific Publishers Pvt. Ltd.
2022-03-01
|
| Series: | Journal of Neuroanaesthesiology and Critical Care |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1732828 |
| _version_ | 1811232026632650752 |
|---|---|
| author | Ankur Dhanda Ashish Bindra Roshni Dhakal Siddharth Chavali Gyaninder P. Singh Pankaj K. Singh Purva Mathur |
| author_facet | Ankur Dhanda Ashish Bindra Roshni Dhakal Siddharth Chavali Gyaninder P. Singh Pankaj K. Singh Purva Mathur |
| author_sort | Ankur Dhanda |
| collection | DOAJ |
| description | Background Pediatric traumatic brain injury (TBI) has distinctive pathophysiology and characteristics that differ from adults. These can be attributed to age-related anatomical and physiological differences and distinct patterns of injuries seen in children. Our aim was to identify the patient characteristics, clinical variables during intensive care and intraoperative management associated with poor functional outcome in a cohort of pediatric TBI patients.
Methods Retrospective chart review of pediatric TBI patients admitted to neurotrauma intensive care unit (NICU) over a period of 1 year.
Results A total of 105 children (< 12 years) with head injury were admitted in the NICU during the study period. The most common mechanism of injury was fall in 78% cases. Fifty-four patients (51.4%) presented with a severe head injury (Glasgow coma scale [GCS] ≤ 8), while 31 (29.5%) and 20 (19.1%) had a mild and moderate head injury. The most common finding was skull fractures (59%), contusions (36.2%), and subdural hematoma (SDH) (30.4%). Forty nine patients (46.7%) required surgical management. The median duration of anesthesia was 205 (interquartile range [IQR] 65, 375) minutes, and median blood loss during the surgery was 16.7 mL/kg body weight with 41% requiring intraoperative blood transfusions. Median duration of ICU and hospital stay was 5 (IQR 1, 47) and 8 (IQR 1, 123) days, respectively. GOS at discharge ≤ 3 representing poor outcome was present in 35 patients (33.3%). Mortality was seen in 15 (14.3%) patients. Multivariate analysis identified postresuscitation GCS ≤ 8 on admission as independent predictor of mortality, and postresuscitation GCS ≤ 8 on admission and NICU stay of > 7 days as independent predictor of poor outcome.
Conclusion Despite advances in neurointensive care, mortality and morbidity remains high in pediatric head trauma and is mainly dependent on postresuscitation GCS and NICU stay of more than 7 days. Multidimensional approach is required for its prevention and management. |
| first_indexed | 2024-04-12T10:56:16Z |
| format | Article |
| id | doaj.art-0e03d9f978064073b01dfc50afc6c1e2 |
| institution | Directory Open Access Journal |
| issn | 2348-0548 2348-926X |
| language | English |
| last_indexed | 2024-04-12T10:56:16Z |
| publishDate | 2022-03-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Neuroanaesthesiology and Critical Care |
| spelling | doaj.art-0e03d9f978064073b01dfc50afc6c1e22022-12-22T03:36:05ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neuroanaesthesiology and Critical Care2348-05482348-926X2022-03-01090102102810.1055/s-0041-1732828Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain InjuryAnkur Dhanda0Ashish Bindra1Roshni Dhakal2Siddharth Chavali3Gyaninder P. Singh4Pankaj K. Singh5Purva Mathur6Department of Neuroanesthesia and Neurocritical Care, Akash Superspeciality Hospital, New Delhi, IndiaDepartment of Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, IndiaJai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, IndiaConsultant, Neuroanaesthesia and Neurocritical Care, AIG Hospitals, Hyderabad, Telangana, IndiaDepartment of Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, IndiaDepartment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, IndiaLab Medicine, Jai Prakash Naraian Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, IndiaBackground Pediatric traumatic brain injury (TBI) has distinctive pathophysiology and characteristics that differ from adults. These can be attributed to age-related anatomical and physiological differences and distinct patterns of injuries seen in children. Our aim was to identify the patient characteristics, clinical variables during intensive care and intraoperative management associated with poor functional outcome in a cohort of pediatric TBI patients. Methods Retrospective chart review of pediatric TBI patients admitted to neurotrauma intensive care unit (NICU) over a period of 1 year. Results A total of 105 children (< 12 years) with head injury were admitted in the NICU during the study period. The most common mechanism of injury was fall in 78% cases. Fifty-four patients (51.4%) presented with a severe head injury (Glasgow coma scale [GCS] ≤ 8), while 31 (29.5%) and 20 (19.1%) had a mild and moderate head injury. The most common finding was skull fractures (59%), contusions (36.2%), and subdural hematoma (SDH) (30.4%). Forty nine patients (46.7%) required surgical management. The median duration of anesthesia was 205 (interquartile range [IQR] 65, 375) minutes, and median blood loss during the surgery was 16.7 mL/kg body weight with 41% requiring intraoperative blood transfusions. Median duration of ICU and hospital stay was 5 (IQR 1, 47) and 8 (IQR 1, 123) days, respectively. GOS at discharge ≤ 3 representing poor outcome was present in 35 patients (33.3%). Mortality was seen in 15 (14.3%) patients. Multivariate analysis identified postresuscitation GCS ≤ 8 on admission as independent predictor of mortality, and postresuscitation GCS ≤ 8 on admission and NICU stay of > 7 days as independent predictor of poor outcome. Conclusion Despite advances in neurointensive care, mortality and morbidity remains high in pediatric head trauma and is mainly dependent on postresuscitation GCS and NICU stay of more than 7 days. Multidimensional approach is required for its prevention and management.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1732828glasgow outcome scoreintensive care unitpediatrictraumatic brain injury |
| spellingShingle | Ankur Dhanda Ashish Bindra Roshni Dhakal Siddharth Chavali Gyaninder P. Singh Pankaj K. Singh Purva Mathur Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury Journal of Neuroanaesthesiology and Critical Care glasgow outcome score intensive care unit pediatric traumatic brain injury |
| title | Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury |
| title_full | Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury |
| title_fullStr | Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury |
| title_full_unstemmed | Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury |
| title_short | Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury |
| title_sort | patient characteristics and clinical and intraoperative variables affecting outcome in pediatric traumatic brain injury |
| topic | glasgow outcome score intensive care unit pediatric traumatic brain injury |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1732828 |
| work_keys_str_mv | AT ankurdhanda patientcharacteristicsandclinicalandintraoperativevariablesaffectingoutcomeinpediatrictraumaticbraininjury AT ashishbindra patientcharacteristicsandclinicalandintraoperativevariablesaffectingoutcomeinpediatrictraumaticbraininjury AT roshnidhakal patientcharacteristicsandclinicalandintraoperativevariablesaffectingoutcomeinpediatrictraumaticbraininjury AT siddharthchavali patientcharacteristicsandclinicalandintraoperativevariablesaffectingoutcomeinpediatrictraumaticbraininjury AT gyaninderpsingh patientcharacteristicsandclinicalandintraoperativevariablesaffectingoutcomeinpediatrictraumaticbraininjury AT pankajksingh patientcharacteristicsandclinicalandintraoperativevariablesaffectingoutcomeinpediatrictraumaticbraininjury AT purvamathur patientcharacteristicsandclinicalandintraoperativevariablesaffectingoutcomeinpediatrictraumaticbraininjury |