Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
Duke-NUS Medical School, SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore.
Acta Neurochir (Wien). 2023 Nov;165(11):3197-3206. doi: 10.1007/s00701-023-05741-0. Epub 2023 Sep 20.
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.
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).
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.
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.
格拉斯哥昏迷量表（GCS）评分为 9-13 的中度创伤性脑损伤（modTBI）儿童可能需要更好的分层。我们旨在比较高 GCS modTBI（hmodTBI，GCS 11-13）、低 GCS modTBI（lmodTBI，GCS 9-10）和重度 TBI（sTBI，GCS≤8）儿童之间神经重症监护的利用和功能结局。我们假设 lmodTBI 患者的神经重症监护需求高于 hmodTBI 患者，且结局差于 sTBI 患者。
这是一项 2018 年 6 月至 2022 年 10 月期间在亚洲、南美洲和欧洲的 28 个儿科重症监护病房（PICU）进行的前瞻性观察性研究。我们纳入了 modTBI 和 sTBI 患儿（年龄<18 岁），并在 3 个月时使用格拉斯哥结局量表-扩展儿科修订版（GOS-E Peds，评分 1-8，1=上佳恢复，8=死亡）评估功能结局。
我们分析了 409 例患者：98 例（24%）和 311 例（76%）为 modTBI 和 sTBI 患儿。lmodTBI 患儿（与 hmodTBI 患儿相比）更有可能接受有创 ICP 监测（32.3%与 4.5%，p<0.001）、PICU 住院时间更长（天数，中位数[IQR]；5.00[4.00，9.75]与 4.00[2.00，5.00]，p=0.007）和住院时间更长（天数，中位数[IQR]：13.00[8.00，17.00]与 8.00[5.00，12，25]，p=0.015）。GOS-E Peds 评分的中位数明显不同（hmodTBI（1.00[1.00，3.00]）、lmodTBI（3.00[IQR 2.00，5.75]）和 sTBI（5.00[IQR 1.00，6.00]）（p<0.001））。在调整了年龄、性别、多发伤和脑水肿的存在后，lmodTBI 和 sTBI 与更高的 GOS-E 评分显著相关（调整后的系数（标准误差）：1.24（0.52），p=0.018 和 1.27（0.33），p<0.001），与 hmodTBI 相比。
lmodTBI 患儿神经重症监护利用率较高，功能结局较 hmodTBI 患儿差，但较 sTBI 患儿好。lmodTBI 患儿可能受益于基于指南的管理，类似于对 sTBI 患儿的管理。这项工作是在 PACCMAN 和 LARed 网络内的医院进行的。不订购任何重印本。
