Children's Emergency, KK Women's and Children's Hospital, Singapore
Children's Emergency, KK Women's and Children's Hospital, Singapore.
Emerg Med J. 2022 Jul;39(7):527-533. doi: 10.1136/emermed-2020-210641. Epub 2021 Aug 3.
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.
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.
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).
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.
儿科创伤性脑损伤（TBI）初始收缩压（SBP）较低与死亡率相关。关于其他血流动力学参数，包括心率（HR）；舒张压（DBP）；平均动脉压（MAP）；休克指数，儿科年龄调整（SIPA）如何不仅影响死亡率，而且影响儿科 TBI 的长期神经结局，文献有限。我们旨在分析这些血流动力学变量（HR、SBP、MAP、DBP 和 SIPA）与孤立性中度至重度儿科 TBI 死亡率和长期神经结局的关系。
这是我们主要研究的二次分析，该研究分析了 TBI 相关凝血障碍与孤立性中度至重度儿科头部损伤的死亡率和神经结局的关系。一项基于创伤登记的回顾性研究，纳入 2010 年 1 月至 2016 年 12 月期间因孤立性中度至重度 TBI 就诊于急诊科的年龄<18 岁的儿童。使用逻辑回归分析受伤后 6 个月时初始血流动力学变量与格拉斯哥结局量表扩展儿科评分较差的关系。
在分析的 152 名儿童中，初始收缩压和舒张压（<5 百分位数）（SBP 的 OR 为 11.40，95%CI 为 3.60 至 36.05，p<0.001；DBP 的 OR 为 15.75，95%CI 为 3.09 至 80.21，p<0.001）和格拉斯哥昏迷量表评分<8（OR 为 14.50，95%CI 为 3.65 至 57.55，p<0.001）与“中重度神经残疾”、“植物人状态”和“死亡”相关。调整混杂因素后，仅 SBP 有意义（调整后的 OR 为 5.68，95%CI 为 1.40 至 23.08，p=0.015）。
初始收缩压降低与受伤后 6 个月时的死亡率和中重度神经缺损独立相关。需要进一步研究以了解早期纠正低血压是否会改善长期结局。
