title: Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay.
abstract: We aim to study the association between hyperglycemia and in-hospital outcomes among children with moderate and severe traumatic brain injury (TBI). This retrospective cohort study was conducted in a tertiary pediatric hospital between 2003 and 2013. All patients < 16 years old who presented to the Emergency Department within 24 hours of head injury with a Glasgow Coma Scale (GCS) ≤ 13 were included. Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days. Hyperglycemia was defined as glucose > 200 mg/dL (11.1 mmol/L). Among the 44 patients analyzed, the median age was 8.6 years (interquartile range (IQR) 5.0-11.0). Median GCS and pediatric trauma scores were 7 (IQR 4-10) and 4 (IQR 3-6), respectively. Initial hyperglycemia was associated with death (37% in the hyperglycemia group versus 8% in the normoglycemia group, p = 0.019), reduced median PICU-free days (6 days versus 11 days, p = 0.006), and reduced median ventilation-free days (8 days versus 12 days, p = 0.008). This association was however not significant in the stratified analysis of patients with GCS ≤ 8. Conclusion. Our findings demonstrate that early hyperglycemia is associated with increased mortality, prolonged duration of mechanical ventilation, and PICU stay in children with TBI.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899 ; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, 100 Bukit Timah Road, Singapore 229899.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chong
authors.affiliation: Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857.
authors.forename: Sumitro
authors.initials: S
authors.lastname: Harjanto
authors.affiliation: Division of Neonatal Medicine, Escola Paulista de Medicina-Universidade Federal de Sao Paulo, Rua Marselhesa 630, Vila Clementino, 04020-060 São Paulo, SP, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Testoni
authors.affiliation: SingHealth Duke-NUS Paediatrics Academic Clinical Programme, 100 Bukit Timah Road, Singapore 229899 ; Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
authors.forename: Zhi Min
authors.initials: ZM
authors.lastname: Ng
authors.affiliation: Department of Neurosurgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
authors.forename: Chyi Yeu David
authors.initials: CY
authors.lastname: Low
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899 ; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, 100 Bukit Timah Road, Singapore 229899.
authors.forename: Khai Pin
authors.initials: KP
authors.lastname: Lee
authors.affiliation: SingHealth Duke-NUS Paediatrics Academic Clinical Programme, 100 Bukit Timah Road, Singapore 229899 ; Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee