Blood pressure and outcome after severe pediatric traumatic brain injury.
BACKGROUND
The relationship between systolic blood pressure and outcome in children after severe traumatic brain injury (TBI) is unclear. We examined the relationship between age-appropriate systolic blood pressure (AASBP) percentile and outcome after severe pediatric TBI.


METHODS
We examined the association between AASBP percentiles and outcome in 172 children younger than 14 years of age with a Glasgow Coma Scale score < 9. Outcome was evaluated using discharge Glasgow Outcome Scale score. Poor outcome was defined as a Glasgow Outcome Scale score < 4.


RESULTS
Poor outcome was associated with AASBP < 75th percentile (odds ratio, 4.2; 95% confidence interval, 2.1-8.3). Patients with systolic blood pressure (SBP) > or = 90 mm Hg and AASBP < 75th percentile had a higher odds for poor outcome compared with patients with SBP > or = 90 mm Hg and AASBP > or = 75th percentile (odds ratio, 3.5; 95% confidence interval, 1.7-7.3). CONCLUSION AASBP < 75th percentile was associated with poor outcome after severe pediatric TBI, even when SBP was > or = 90 mm Hg.
Vavilala
Monica S
MS
Department of Anesthesiology, Harborview Medical Center, University of Washington, Seattle, USA. vavilala@u.washington.edu
Bowen
Anna
A
Lam
Arthur M
AM
Uffman
Joshua C
JC
Powell
Jeffrey
J
Winn
H Richard
HR
Rivara
Frederick P
FP
D000046:Academic Medical Centers; D017677:Age Distribution; D000704:Analysis of Variance; D001794:Blood Pressure; D001930:Brain Injuries / Q000150:complications* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015986:Confounding Factors, Epidemiologic; D016002:Discriminant Analysis; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013599:Systole; D014193:Trauma Centers; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology