Acute hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury.
OBJECTIVE
Hyperglycemia in the acute phase after trauma could adversely affect outcome in children with severe traumatic brain injury (TBI). The goal of this study was to identify the relationship between acute spontaneous hyperglycemia and outcome in children with severe TBI at hospital discharge and 6 months later.


METHODS
A retrospective analysis of blood glucose levels in children with severe TBI at a Pediatric level I Trauma Center, between January 2000 and December 2005. Hyperglycemia was considered for a cut-off value of 11.1 mmol/l (200 mg/dl). Outcome was measured with Glasgow Outcome Scale (GOS) at hospital discharge and at 6 months. A multiple logistic regression analysis, the Student's t test and the chi (2) test were done.


RESULTS
Hyperglycemia was noted within the first 48 h in 34% of the patients. Mortality (70% vs 14%, p < 10(-5)) was more frequent in hyperglycemic children and bad outcome upon hospital discharge in those who remained hyperglycemic during the first 48 h of hospitalization. GOS after 6 months demonstrated that those normoglycemic children had a better outcome (95%) than those who developed hyperglycemia during the first 48 h (83%, p = 0.01) after trauma.


CONCLUSIONS
Hyperglycemia could be considered as a marker of brain injury and when present upon admission, could reflect extensive brain damage with frequently associated mortality and bad outcome. The inability to maintain normal blood glucose levels during the first 48 h could be a predictive factor of bad outcome. Avoiding hyperglycemia in the initial phase could be a major issue in children with severe TBI.
Melo
José Roberto Tude
JR
Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France), Université Descartes Paris 5, Paris, France. robertotude@gmail.com
Di Rocco
Federico
F
Blanot
Stéphane
S
Laurent-Vannier
Anne
A
Reis
Rodolfo Casimiro
RC
Baugnon
Thomas
T
Sainte-Rose
Christian
C
Olveira-Filho
Jamary
J
Zerah
Michel
M
Meyer
Philippe
P
D000208:Acute Disease; D000293:Adolescent; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000401:mortality; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index