Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma.
OBJECTIVE
The objective of this study was to determine the morbidity associated with hypotension in the resuscitative phase of pediatric head trauma.


METHODS
A retrospective review (1990 to 1995) was performed at a level-1 pediatric trauma facility. Inclusion criteria included a Glasgow coma score (GCS) of 6 to 8 and absence of penetrating trauma or bleeding disorders. The GCS was assigned using a postresuscitation examination by a neurosurgeon. Hypotension was defined as a blood pressure reading of less than the fifth percentile for age that lasted longer than 5 minutes. Episodes were monitored from the onset of injury through the first 24 hours of hospitalization. Glasgow outcome scale (GOS) was assigned based on a 3-month follow-up evaluation. Analysis of variance (ANOVA) and contingency table analysis were performed on all groups, and a P value of less than .05 was taken to represent statistical significance.


RESULTS
Seventy-two patients met inclusion criteria. They had a mean GCS of 7.2 and a mean age of 6 years; 97% survived. Early hypotension was associated with worse neurological outcome (GOS) and prolonged hospitalization. There was no significant correlation between GOS and age, gender, injury mechanism, associated injuries, or transport time.


CONCLUSIONS
These data suggest that maintaining adequate blood pressure during the early resuscitation of pediatric blunt head trauma patients may improve neurological outcome.
Kokoska
E R
ER
Department of Surgery, St Louis University Health Sciences Center and Cardinal Glennon Children's Hospital, Missouri 63104, USA.
Smith
G S
GS
Pittman
T
T
Weber
T R
TR
D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D008297:Male; D009017:Morbidity; D012151:Resuscitation; D012189:Retrospective Studies; D013997:Time Factors