title: Young age as a risk factor for impaired cerebral autoregulation after moderate to severe pediatric traumatic brain injury.
abstract: BACKGROUND
  Little is known about age and cerebral autoregulation in children with traumatic brain injury (TBI). The authors compared cerebral autoregulation between young (aged <4 yr) and older (aged > or =4 yr) children with TBI.
  
  
  METHODS
  After University of Washington's institutional review board approval, a retrospective analysis of prospectively collected data (May 2002 and June 2007) was performed. Eligibility criteria included age 16 yr or younger, moderate to severe (admission Glasgow Coma Scale score <13) TBI, TBI on computed tomography scan, and tracheal intubation. Cerebral autoregulation testing was performed within 72 h after TBI, and autoregulation was quantified using the autoregulatory index. An autoregulatory index less than 0.4 represents impaired cerebral autoregulation. The 12-month Glasgow outcome score was measured. Data are presented as mean +/- SD or range.
  
  
  RESULTS
  Thirty-seven children (8.9 +/- 5.1 yr; 0.8-16 yr) were enrolled. Children younger than 4 yr had a higher incidence of impaired cerebral autoregulation (8 of 10 vs. 7 of 27; P = 0.006) and worse 12-month outcome (Glasgow outcome score 3.0 +/- 1.0 vs. 4.0 +/- 1.0; P = 0.02) than older children. Age less than 4 yr (adjusted odds ratio, 12.2; 95% confidence interval, 1.5-98.5) and low Glasgow Coma Scale score (adjusted odds ratio for higher Glasgow Coma Scale, 0.53; 95% confidence interval, 0.30-0.96) were independently associated with impaired cerebral autoregulation.
  
  
  CONCLUSIONS
  Age less than 4 yr was a risk factor for impaired cerebral autoregulation, independent of TBI severity. Age-related factors may play a role in the mechanisms maintaining or worsening cerebral autoregulation in children after TBI.
authors: University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.
authors: Serena S
authors: SS
authors: Freeman
authors: Yuthana
authors: Y
authors: Udomphorn
authors: William M
authors: WM
authors: Armstead
authors: Dana M
authors: DM
authors: Fisk
authors: Monica S
authors: MS
authors: Vavilala
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001921:Brain / Q000098:blood supply / Q000502:physiology*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors