Division of Pediatric Critical Care, Phoenix Children's, Phoenix, AZ, USA.
University of Arizona-COM Phoenix, Phoenix, AZ, USA.
J Child Neurol. 2024 Jun;39(7-8):275-284. doi: 10.1177/08830738241269128. Epub 2024 Sep 9.
Studies suggest disparities in outcomes in minoritized children after severe traumatic brain injury. We aimed to evaluate for disparities in intracranial pressure-directed therapies and outcomes after pediatric severe traumatic brain injury.
We conducted a secondary analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial, which enrolled pediatric severe traumatic brain injury patients (Glasgow Coma Scale score ≤8) with an intracranial pressure monitor from 2014 to 2018. Patients admitted outside of the United States were excluded. Patients were categorized by race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, and "Other"). We evaluated outcomes by assessing mortality and 3-month Glasgow Outcome Score-Extended for Pediatrics. Our analysis involved parametric and nonparametric testing.
A total of 671 children were analyzed. Significant associations included older age in non-Hispanic White patients (< .001), more surgical evacuations in "Other" (< .001), and differences in discharge location (= .040). The "other" cohort received hyperventilation less frequently (= .046), although clinical status during Paco measurement was not known. There were no other significant differences in intracranial pressure-directed therapies. Hispanic ethnicity was associated with lower mortality (= .004) but did not differ in unfavorable outcome (= .810). Glasgow Outcome Score-Extended for Pediatrics was less likely to be collected for non-Hispanic Black patients (69%; = .011).
Our analysis suggests a general lack of disparities in intracranial pressure-directed therapies and outcomes in children after severe traumatic brain injury. Lower mortality in Hispanic patients without a concurrent decrease in unfavorable outcomes, and lower availability of Glasgow Outcome Score-Extended for Pediatrics score for non-Hispanic Black patients merit further investigation.
有研究表明，少数族裔儿童在经历严重创伤性脑损伤后的结局存在差异。本研究旨在评估小儿严重创伤性脑损伤患者接受颅内压导向治疗的差异及其结局。
我们对 2014 年至 2018 年期间入组的伴有颅内压监测的小儿严重创伤性脑损伤患者（格拉斯哥昏迷量表评分≤8 分）的急性儿科创伤治疗方法和决策（ADAPT）试验进行了二次分析。排除了在美国以外地区入院的患者。患者根据种族和民族（西班牙裔、非西班牙裔黑种人、非西班牙裔白种人和“其他”）进行分类。通过评估死亡率和 3 个月时的儿科格拉斯哥预后评分扩展（GOSE-Peds）来评估结局。我们的分析涉及参数和非参数检验。
共分析了 671 例患儿。非西班牙裔白种人患者年龄较大（<0.001），“其他”患者接受手术清除的比例更高（<0.001），出院地点不同（=0.040）。“其他”患者接受过度通气的频率较低（=0.046），但尚不清楚 Paco 测量期间的临床状况。在颅内压导向治疗方面没有其他显著差异。西班牙裔患儿的死亡率较低（=0.004），但结局不良的比例无差异（=0.810）。非西班牙裔黑种患儿获得 GOSE-Peds 评分的可能性较低（69%；=0.011）。
本研究分析提示，小儿严重创伤性脑损伤患者在接受颅内压导向治疗和结局方面普遍不存在差异。西班牙裔患儿的死亡率较低，且结局不良的比例无变化，而非西班牙裔黑种患儿的 GOSE-Peds 评分可用性较低，这些现象值得进一步研究。
