Hyperglycemia: an independent risk factor for poor outcome in children with traumatic brain injury*.
OBJECTIVE
We sought 1) to describe the severity and duration of hyperglycemia among surviving and dying children after traumatic brain injury; 2) to evaluate whether persistent severe hyperglycemia (averaged blood glucose > 200 mg/dL [11 mmol/L] during the first 12 hr after injury) is independently associated with poor Glasgow Outcome Score; and 3) to evaluate different definitions and the prevalence of poor Glasgow Outcome Score to better understand measurement and potential hyperglycemia treatment evaluation.


METHODS
Retrospective cohort.


METHODS
Level I American College of Surgery verified pediatric trauma center.


METHODS
Children admitted to intensive care with moderate-to-severe traumatic brain injury.


METHODS
None.


RESULTS
Time course for glucose changes was compared by survival and blood glucose groups. Twelve-hour averaged patient blood glucoses were categorized as persistent: severe hyperglycemia (> 200 mg/dL [11 mmol/L]), moderate hyperglycemia (161-200 mg/dL [9-11 mmol/L]), mild hyperglycemia (110-160 mg/dL [6-9 mmol/L]), normal glycemia (80-109 mg/dL [4-6 mmol/L]), or hypoglycemia (< 80 mg/dL [< 4 mmol/L]). Among 271 children, less than 1% had hypoglycemia and were excluded from further analysis. Seven percent had normal, 49% had mild, 24% had moderate, and 20% had severe blood glucose elevation. Among dying children (n = 44, 16%), the mean blood glucose at 20-24 hours after injury was significantly greater compared with survivors (150 vs 113 mg/dL [8 vs 6 mmol/L]) but by 29-32 hours, no longer significantly differed (112 vs 102 mg/dL [6 mmol/L]). Sixty-eight percent of children with severe blood glucose elevation had a poor outcome, whereas good outcomes at discharge occurred in 87% with mild or moderate blood glucose elevation. Severe blood glucose elevation was associated with a 3.5-fold increased adjusted odds ratio of poor outcome (95% CI, 1.2-10.3) compared with mild blood glucose elevation adjusted for injury severity and cardiorespiratory instability.


CONCLUSIONS
Duration of severe blood glucose elevation (blood glucose > 200 mg/dL [11 mmol/L]) was brief but remained independently associated with poor outcome.
1Department of Pediatrics, University of Utah, Salt Lake City, UT. 2Department of Neurosurgery, University of Utah, Salt Lake City, UT. 3Department of Internal Medicine, University of Utah, Salt Lake City, UT.
Benjamin
B
Elkon
Jay Riva
JR
Cambrin
Eliotte
E
Hirshberg
Susan L
SL
Bratton
D001786:Blood Glucose / Q000378:metabolism; D001930:Brain Injuries / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D007223:Infant; D007902:Length of Stay; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose