The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience
ObjectivesTo describe the use and outcomes of the neurological wake-up test (NWT) in pediatric severe traumatic brain injury (pTBI).DesignRetrospective single-center observational cohort study.SettingMedical-surgical tertiary pediatric intensive care unit (PICU) in a university medical center and Le...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2024.1367337/full |
| _version_ | 1797299738454786048 |
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| author | Hilde D. Mulder Jelte Helfferich Martin C. J. Kneyber |
| author_facet | Hilde D. Mulder Jelte Helfferich Martin C. J. Kneyber |
| author_sort | Hilde D. Mulder |
| collection | DOAJ |
| description | ObjectivesTo describe the use and outcomes of the neurological wake-up test (NWT) in pediatric severe traumatic brain injury (pTBI).DesignRetrospective single-center observational cohort study.SettingMedical-surgical tertiary pediatric intensive care unit (PICU) in a university medical center and Level 1 Trauma Center.PatientsChildren younger than 18 years with severe TBI [i.e., Glasgow Coma Scale (GCS) of ≤8] admitted between January 2010 and December 2020. Subjects with non-traumatic brain injury were excluded.Measurements and main resultsOf 168 TBI patients admitted, 36 (21%) met the inclusion criteria. Median age was 8.5 years [2 months to 16 years], 5 patients were younger than 6 months. Median initial Glasgow Coma Scale (GCS) and Glasgow Motor Scale (GMS) was 6 [3–8] and 3 [1–5]. NWTs were initiated in 14 (39%) patients, with 7 (50%) labelled as successful. Fall from a height was the underlying injury mechanism in those seven. NWT-failure occurred in patients admitted after traffic accidents. Sedation use in both NWT-subgroups (successful vs. failure) was comparable. Cause of NWT-failure was non-arousal (71%) or severe agitation (29%). Subjects with NWT failure subsequently had radiological examination (29%), repeat NWT (43%), continuous interruption of sedation (14%) or intracranial pressure (ICP) monitoring (14%). The primary reason for not doing NWTs was intracranial hypertension in 59%. Compared to the NWT-group, the non-NWT group had a higher PRISM III score (18.9 vs. 10.6), lower GCS/GMS at discharge, more associated trauma, and circulatory support. Nine patients (25%) died during their PICU admission, none of them had an NWT.ConclusionWe observed limited use of NWTs in pediatric severe TBI. Patients who failed the NWT were indistinguishable from those without NWT. Both groups were more severely affected compared to the NWT successes. Therefore, our results may indicate that only a select group of severe pTBI patients qualify for the NWT. |
| first_indexed | 2024-03-07T22:55:00Z |
| format | Article |
| id | doaj.art-197d426f49be46ec92f02f5be2bb5087 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-07T22:55:00Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-197d426f49be46ec92f02f5be2bb50872024-02-23T04:49:45ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-02-011210.3389/fped.2024.13673371367337The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experienceHilde D. Mulder0Jelte Helfferich1Martin C. J. Kneyber2Department of Pediatrics, Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Neurology, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsDepartment of Pediatrics, Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, NetherlandsObjectivesTo describe the use and outcomes of the neurological wake-up test (NWT) in pediatric severe traumatic brain injury (pTBI).DesignRetrospective single-center observational cohort study.SettingMedical-surgical tertiary pediatric intensive care unit (PICU) in a university medical center and Level 1 Trauma Center.PatientsChildren younger than 18 years with severe TBI [i.e., Glasgow Coma Scale (GCS) of ≤8] admitted between January 2010 and December 2020. Subjects with non-traumatic brain injury were excluded.Measurements and main resultsOf 168 TBI patients admitted, 36 (21%) met the inclusion criteria. Median age was 8.5 years [2 months to 16 years], 5 patients were younger than 6 months. Median initial Glasgow Coma Scale (GCS) and Glasgow Motor Scale (GMS) was 6 [3–8] and 3 [1–5]. NWTs were initiated in 14 (39%) patients, with 7 (50%) labelled as successful. Fall from a height was the underlying injury mechanism in those seven. NWT-failure occurred in patients admitted after traffic accidents. Sedation use in both NWT-subgroups (successful vs. failure) was comparable. Cause of NWT-failure was non-arousal (71%) or severe agitation (29%). Subjects with NWT failure subsequently had radiological examination (29%), repeat NWT (43%), continuous interruption of sedation (14%) or intracranial pressure (ICP) monitoring (14%). The primary reason for not doing NWTs was intracranial hypertension in 59%. Compared to the NWT-group, the non-NWT group had a higher PRISM III score (18.9 vs. 10.6), lower GCS/GMS at discharge, more associated trauma, and circulatory support. Nine patients (25%) died during their PICU admission, none of them had an NWT.ConclusionWe observed limited use of NWTs in pediatric severe TBI. Patients who failed the NWT were indistinguishable from those without NWT. Both groups were more severely affected compared to the NWT successes. Therefore, our results may indicate that only a select group of severe pTBI patients qualify for the NWT.https://www.frontiersin.org/articles/10.3389/fped.2024.1367337/fulltraumatic brain injurypediatricneurocritical carewake-up testNWT |
| spellingShingle | Hilde D. Mulder Jelte Helfferich Martin C. J. Kneyber The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience Frontiers in Pediatrics traumatic brain injury pediatric neurocritical care wake-up test NWT |
| title | The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience |
| title_full | The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience |
| title_fullStr | The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience |
| title_full_unstemmed | The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience |
| title_short | The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience |
| title_sort | neurological wake up test in severe pediatric traumatic brain injury a long term single center experience |
| topic | traumatic brain injury pediatric neurocritical care wake-up test NWT |
| url | https://www.frontiersin.org/articles/10.3389/fped.2024.1367337/full |
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