Department of Pediatrics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Pediatr Crit Care Med. 2018 Apr;19(4):353-360. doi: 10.1097/PCC.0000000000001490.
We analyzed a prospective database of pediatric traumatic brain injury patients to identify predictors of outcome and describe the change in function over time. We hypothesized that neurologic status at hospital discharge would not reflect the long-term neurologic recovery state.
This is a descriptive cohort analysis of a single-center prospective database of pediatric traumatic brain injury patients from 2001 to 2012. Functional outcome was assessed at hospital discharge, and the Glasgow Outcome Scale Extended Pediatrics or Glasgow Outcome Scale was assessed on average at 15.8 months after injury.
Children's Medical Center Dallas, a single-center PICU and Level 1 Trauma Center.
Patients, 0-17 years old, with complicated-mild/moderate or severe accidental traumatic brain injury.
Dichotomized long-term outcome was favorable in 217 of 258 patients (84%), 80 of 82 patients (98%) with complicated-mild/moderate injury and 133 of 172 severe patients (77%). In the bivariate analysis, younger age, motor vehicle collision as a mechanism of injury, intracranial pressure monitor placement, cardiopulmonary resuscitation at scene or emergency department, increased hospital length of stay, increased ventilator days (all with p < 0.01) and occurrence of seizures (p = 0.03) were significantly associated with an unfavorable outcome. In multiple regression analysis, younger age (p = 0.03), motor vehicle collision (p = 0.01), cardiopulmonary resuscitation (p < 0.01), and ventilator days (p < 0.01) remained significant. Remarkably, 28 of 60 children (47%) with an unfavorable Glasgow Outcome Scale at hospital discharge improved to a favorable outcome. In severe patients with an unfavorable outcome at hospital discharge, younger age was identified as a risk factor for remaining in an unfavorable condition (p = 0.1).
Despite a poor neurologic status at hospital discharge, many children after traumatic brain injury will significantly improve at long-term assessment. The factors most associated with outcomes were age, cardiopulmonary resuscitation, motor vehicle collision, intracranial pressure placement, days on a ventilator, hospital length of stay, and seizures. The factor most associated with improvement from an unfavorable neurologic status at discharge was being older.
我们分析了一项前瞻性儿科创伤性脑损伤患者数据库，以确定预后的预测因素，并描述随时间推移的功能变化。我们假设，出院时的神经状态不能反映长期的神经恢复状态。
这是对 2001 年至 2012 年期间单一中心前瞻性儿科创伤性脑损伤患者数据库的描述性队列分析。在出院时评估功能结局，并在受伤后平均 15.8 个月评估格拉斯哥结局量表扩展儿科或格拉斯哥结局量表。
达拉斯儿童医疗中心，一个单一中心的 PICU 和 1 级创伤中心。
0-17 岁，伴有复杂轻度/中度或重度意外创伤性脑损伤的患者。
258 例患者中有 217 例（84%）、82 例伴有复杂轻度/中度损伤的患者中有 80 例（98%）和 172 例严重损伤的患者中有 133 例（77%）的长期结局为有利。在单变量分析中，年龄较小、机动车碰撞为损伤机制、颅内压监测放置、现场或急诊科心肺复苏、住院时间延长、呼吸机天数增加（均 p < 0.01）和癫痫发作（p = 0.03）与不良结局显著相关。在多变量回归分析中，年龄较小（p = 0.03）、机动车碰撞（p = 0.01）、心肺复苏（p < 0.01）和呼吸机天数（p < 0.01）仍然是显著的。值得注意的是，60 例格拉斯哥结局量表在出院时预后不良的患儿中有 28 例（47%）改善为预后良好。在出院时预后不良的严重患者中，年龄较小是预后不良的危险因素（p = 0.1）。
尽管出院时神经状态较差，但许多创伤性脑损伤后儿童在长期评估中会显著改善。与结局最相关的因素是年龄、心肺复苏、机动车碰撞、颅内压放置、呼吸机使用天数、住院时间和癫痫发作。与出院时神经状态不良的改善最相关的因素是年龄较大。
