Traumatic brain injury in childhood: intensive care time series data and outcome.
Age-specific norms are necessary to determine potential secondary brain insult after head injury in children. We describe and quantify the secondary physiological derangement recorded in children of different ages following traumatic brain injury, and relate it to outcome at 12 months post-injury. Prospective time-series data (including intracranial pressure, arterial blood pressure, cerebral perfusion pressure, oxygen saturation, temperature and heart rate) downloaded from ICU monitors, were examined to identify abnormal (i.e. outside normal age-specific limits) recordings lasting more than 5 min. Cumulated total duration of derangement was calculated for each parameter and as a percentage of the time that the ICP monitor was in situ. Univariate and multivariate logistic regression modelling was used to evaluate predictors of outcome. Age-specificity allows realistic comparisons of physiological data among children. Duration of age-specific derangement of CPP was found to predict outcome (dead v. alive: p = 0.003 and Glasgow Outcome Score 1-3 v. 4-5, i.e. poor v. independent outcome p = 0.004).
Jones
P A
PA
Department of Child Life and Health, University of Edinburgh, Royal Hospital for Sick Children, Edinburgh, Scotland, UK.
Andrews
P J D
PJ
Easton
V J
VJ
Minns
R A
RA
D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature / Q000502:physiology; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008991:Monitoring, Physiologic; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors