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Associations of initial haemodynamic profiles and neurological outcomes in children with traumatic brain injury: a secondary analysis
  1. Sarah Hui Wen Yao1,
  2. Shu-Ling Chong1,2,
  3. Vigil James1,
  4. Khai Pin Lee1,2,
  5. Gene Yong-Kwang Ong1,2
  1. 1Children's Emergency, KK Women's and Children's Hospital, Singapore
  2. 2Department of Emergency Medicine, Duke-NUS Medical School, Singapore
  1. Correspondence to Sarah Hui Wen Yao, Children's Emergency, KK Women's and Children's Hospital, Singapore; sarahyaohuiwen{at}gmail.com

Abstract

Introduction Initial low systolic blood pressure (SBP) in paediatric traumatic brain injury (TBI) is associated with mortality. There is limited literature on how other haemodynamic parameters including heart rate (HR); diastolic blood pressure (DBP); mean arterial pressure (MAP); and shock index, paediatric age-adjusted (SIPA) affect not only mortality but also long-term neurological outcomes in paediatric TBI. We aimed to analyse the associations of these haemodynamic variables (HR, SBP, MAP, DBP and SIPA) with mortality and long-term neurological outcomes in isolated moderate-to-severe paediatric TBI.

Methods This was a secondary analysis of our primary study that analysed the association of TBI-associated coagulopathy with mortality and neurological outcome in isolated, moderate-to-severe paediatric head injury. A trauma registry-based, retrospective study of children <18 years old who presented to the emergency department with isolated, moderate-to-severe TBI from January 2010 to December 2016 was conducted. The association between initial haemodynamic variables and less favourable outcomes using Glasgow Outcome Scale-Extended Paediatric) at 6 months post injury was analysed using logistic regression.

Results Among 152 children analysed, initial systolic and diastolic hypotension (<5th percentile) (OR) for SBP 11.40, 95% CI 3.60 to 36.05, p<0.001; OR for DBP 15.75, 95% CI 3.09 to 80.21, p<0.001) and Glasgow Coma Scale scores <8 (OR 14.50, 95% CI 3.65 to 57.55, p<0.001) were associated with ‘moderate-to-severe neurological disabilities’, ‘vegetative state’ and ‘death’. After adjusting for confounders, only SBP was significant (adjusted OR 5.68, 95% CI 1.40 to 23.08, p=0.015).

Conclusions Initial systolic hypotension was independently associated with mortality and moderate-to-severe neurological deficits at 6 months post injury. Further work is required to understand if early correction of hypotension will improve long-term outcomes.

  • emergency care systems
  • emergency departments
  • paediatric emergency med
  • paediatrics
  • paediatric resuscitation
  • trauma
  • head

Data availability statement

Data are available upon reasonable request. Further study data may be made available upon request.

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Data availability statement

Data are available upon reasonable request. Further study data may be made available upon request.

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Footnotes

  • Handling editor Jason E Smith

  • Contributors GY-KO conceptualised and designed the study. S-LC performed the formal analysis of the data. All authors revised it critically for important intellectual content and approved the final version to be submitted. The authors have full access to all aspects of the research and writing process and take final responsibility for the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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