title: Hyperglycemia is associated with intracranial injury in children younger than 3 years of age.
abstract: OBJECTIVE
  The objective was to see if hyperglycemia in the emergency department predicted traumatic intracranial hemorrhage (ICH) for infants and young children.
  
  
  METHODS
  A 6-year retrospective chart review was performed on patients younger than 3 years. Patients identified from the pediatric intensive care unit (PICU) database with ICH on computer tomography were compared with those with a history of trauma without ICH identified from a radiology database. Subgroup analysis was performed on the ICH group comparing abusive head trauma (AHT) and accidental. Primary outcomes measured were initial serum glucose level, length of stay, length of ventilation, mortality, and disability on discharge.
  
  
  RESULTS
  Fifty-three patients were admitted to the PICU with traumatic ICH with an overall mortality of 7.5%. The average initial glucose in the emergency department was significantly higher for the patients with ICH than those without (164 vs. 99 mg/dL, P < 0.0001). Combining elevated serum glucose with any abnormality in Glasgow Coma Scale score yielded sensitivity and specificity of 100%. The average presenting glucose was higher for AHT compared with accidental injury (190 vs. 133 mg/dL, P < 0.001). Patients with AHT had greater PICU and hospital length of stay and more severe disabilities on discharge (P < 0.001).
  
  
  CONCLUSIONS
  Elevated serum glucose is a good marker of ICH in children younger than 3 years. When correlated with an abnormal neurological examination, it is highly sensitive and specific. Patients with AHT have further elevation of serum glucose at presentation. Emergency department physicians should consider measuring the serum glucose in children younger than 3 years with abnormal neurological examinations and obtaining a head computer tomography if it is elevated.
authors: Pediatric Critical Care, Miller Children's Hospital, Long Beach, CA 90806, USA. cbabbitt@memorialcare.org
authors: Christopher J
authors: CJ
authors: Babbitt
authors: Rebekah
authors: R
authors: Halpern
authors: Eileen
authors: E
authors: Liao
authors: Khanh
authors: K
authors: Lai
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D016009:Chi-Square Distribution; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000401:mortality; D007223:Infant; D015278:Intensive Care Units, Pediatric; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
chemical_list: D001786:Blood Glucose