Hale Andrew T, Pekala Kelly, Theobald Benjamin, Kelly Katherine, Wolf Michael, Wellons John C, Le Truc, Shannon Chevis N
Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA.
Vanderbilt University School of Medicine, 2200 Pierce Avenue, 610 RRB, Nashville, TN, 37232, USA.
Childs Nerv Syst. 2018 Jul;34(7):1361-1365. doi: 10.1007/s00381-018-3779-9. Epub 2018 Mar 21.
In traumatic brain injury (TBI), hyperglycemia and hypothermia are thought to be associated with poor outcomes, but have not been systematically studied in children. Thus, our aim was to evaluate whether serum glucose and temperature at admission, among other clinical variables, were associated with need for post hospital-discharge seizure medication in children diagnosed with TBI.
We performed a retrospective study of 1814 children who were diagnosed with TBI at a tertiary pediatric hospital. Serum glucose levels at admission and temperature at initial presentation, 12, and 24 h were collected. Ongoing seizure activity was defined as discharge prescription of a seizure-modifying medication.
We identified 121 patients with need for continued seizure medications, and 80 patients expired. Independent predictors of prolonged seizures included serum glucose levels above 140 mg/dl (p < 0.003) and 199 mg/dl (p < 0.001), hypothermia (<35 °C), subdural hematoma (p < 0.001), midline shift (p < 0.001), and > 1% temperature change in the first 24 h (p < 0.001). Multivariate regression adjusting for GCS revealed that bilateral bleed (p = 0.008), body-temperature instability (p = 0.026), subdural hematoma (p < 0.001), and mechanism of injury (p = 0.007) were predictive of prolonged seizure activity.
In summary, we conclude that body temperature may be playing a more significant role than glycemic control in propensity for ongoing seizure activity in children sustaining TBI.
在创伤性脑损伤（TBI）中，高血糖和体温过低被认为与不良预后相关，但尚未在儿童中进行系统研究。因此，我们的目的是评估入院时的血糖和体温以及其他临床变量是否与诊断为TBI的儿童出院后需要使用抗癫痫药物有关。
我们对一家三级儿科医院诊断为TBI的1814名儿童进行了回顾性研究。收集入院时的血清葡萄糖水平以及初次就诊、12小时和24小时时的体温。持续性癫痫活动定义为开具抗癫痫药物出院处方。
我们确定了121名需要持续使用抗癫痫药物的患者，80名患者死亡。癫痫持续时间的独立预测因素包括血清葡萄糖水平高于140mg/dl（p<0.003）和199mg/dl（p<0.001）、体温过低（<35°C）、硬膜下血肿（p<0.001）、中线移位（p<0.001）以及最初24小时内体温变化>1%（p<0.001）。对格拉斯哥昏迷量表（GCS）进行校正的多变量回归显示，双侧出血（p=0.008）、体温不稳定（p=0.026）、硬膜下血肿（p<0.001）和损伤机制（p=0.007）可预测癫痫持续时间延长。
总之，我们得出结论，在遭受TBI的儿童中，体温在癫痫持续发作倾向方面可能比血糖控制发挥更重要的作用。
