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20-09-2023 | Central Nervous System Trauma | Original Article

A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries—time to reappraise thresholds for treatment

Authors: Syeda Kashfi Qadri, Jan Hau Lee, Yanan Zhu, Paula Caporal, Juan D Roa G, Sebastián González-Dambrauskas, Adriana Yock-Corrales, Qalab Abbas, Yasser Kazzaz, Luming Shi, Dianna Sri Dewi, Shu-Ling Chong, On behalf of Pediatric Acute, Critical Care Medicine Asian Network (PACCMAN), Pediatric collaborative Latin American network (LARed)

Published in: Acta Neurochirurgica | Issue 11/2023

Abstract

Purpose

Children with moderate traumatic brain injury (modTBI) (Glasgow Coma Scale (GCS) 9–13) may benefit from better stratification. We aimed to compare neurocritical care utilization and functional outcomes between children with high GCS modTBI (hmodTBI, GCS 11–13), low GCS modTBI (lmodTBI, GCS 9–10), and severe TBI (sTBI, GCS ≤ 8). We hypothesized that patients with lmodTBI have higher neurocritical care needs and worse outcomes than patients with hmodTBI and are similar to patients with sTBI.

Methods

Prospective observational study from June 2018 to October 2022 in 28 pediatric intensive care units (PICU) in Asia, South America, and Europe. We included children (age < 18 years) with modTBI and sTBI admitted to PICU and measured functional outcomes at 3 months using the Glasgow Outcome Scale–Extended Pediatric Revision (GOS-E Peds, scale 1–8, 1 = upper good recovery, 8 = death).

Results

We analyzed 409 patients: 98 (24%) and 311 (76%) with modTBI and sTBI, respectively. Patients with lmodTBI (vs. hmodTBI) were more likely to have invasive ICP monitoring (32.3% vs. 4.5%, p < 0.001), longer PICU stay (days, median [IQR]; 5.00 [4.00, 9.75] vs 4.00 [2.00, 5.00], p = 0.007), and longer hospital stay (days, median [IQR]: 13.00 [8.00, 17.00] vs. 8.00 [5.00, 12, 25], p = 0.015). Median GOS-E Peds scores were significantly different (hmodTBI (1.00 [1.00, 3.00]), lmodTBI (3.00 [IQR 2.00, 5.75]), and sTBI (5.00 [IQR 1.00, 6.00]) (p < 0.001)). After adjusting for age, sex, presence of polytrauma and cerebral edema, lmodTBI, and sTBI remained significantly associated with higher GOS-E scores (adjusted coefficient (standard error): 1.24 (0.52), p = 0.018, and 1.27 (0.33), p < 0.001, respectively) compared with hmodTBI.

Conclusions

Children with lmodTBI have higher rates of neurocritical care utilization and worse functional outcomes than those with hmodTBI but better than those with sTBI. Children with lmodTBI may benefit from guideline-based management similar to what is implemented in children with sTBI.

This work was performed in hospitals within the PACCMAN and LARed networks.

No reprints will be ordered.

Available only for authorised users

About PACCMAN. https://www.scri.edu.sg/crn/pediatric-acute-critical-care-medicine-asian-network/about-paccman/. Accessed 31 Oct 2022

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Title: A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries—time to reappraise thresholds for treatment
Authors: Syeda Kashfi Qadri
Jan Hau Lee
Yanan Zhu
Paula Caporal
Juan D Roa G
Sebastián González-Dambrauskas
Adriana Yock-Corrales
Qalab Abbas
Yasser Kazzaz
Luming Shi
Dianna Sri Dewi
Shu-Ling Chong
On behalf of Pediatric Acute, Critical Care Medicine Asian Network (PACCMAN)
Pediatric collaborative Latin American network (LARed)
Publication date: 20-09-2023
Publisher: Springer Vienna
Keywords: Central Nervous System Trauma
Intracranial Hypertension
Coma
Polytrauma
Polytrauma
Pediatric Intensive Care
Published in: Acta Neurochirurgica / Issue 11/2023
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-023-05741-0

At a glance: The STEP trials

Springer Medicine

A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries—time to reappraise thresholds for treatment

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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