title: Timely Hemodynamic Resuscitation and Outcomes in Severe Pediatric Traumatic Brain Injury: Preliminary Findings.
abstract: OBJECTIVE
  Early resuscitation may improve outcomes in pediatric traumatic brain injury (TBI). We examined the association between timely treatment of hypotension and hypoxia during early care (prehospital or emergency department locations) and discharge outcomes in children with severe TBI.
  
  
  METHODS
  Hypotension was defined as systolic blood pressure less than 70 + 2 (age in years), and hypoxia was defined as PaO2 less than 60 mm Hg or oxygen saturation less than 90% in accordance with the 2003 Brain Trauma Foundation guidelines. Timely treatment of hypotension and hypoxia during early care was defined as the treatment within 30 minutes of a documented respective episode. Two hundred thirty-six medical records of children younger than 18 years with severe TBI from 5 regional pediatric trauma centers were examined. Main outcomes were in-hospital mortality and discharge Glasgow Outcome Scale (GOS) score.
  
  
  RESULTS
  Hypotension occurred in 26% (60/234) during early care and was associated with in-hospital mortality (23.3% vs 8.6%; P = 0.01). Timely treatment of hypotension during early care occurred in 92% (55/60) by use of intravenous fluids, blood products, or vasopressors and was associated with reduced in-hospital mortality [adjusted relative risk (aRR), 0.46; 95% confidence interval, 0.24-0.90] and less likelihood of poor discharge GOS (aRR, 0.54; 95% confidence interval, 0.39-0.76) when compared to children with hypotension who were not treated in a timely manner. Early hypoxia occurred in 17% (41/236) and all patients received timely oxygen treatment.
  
  
  CONCLUSIONS
  Timely resuscitation during early care was common and associated with lower in-hospital mortality and favorable discharge GOS in severe pediatric TBI.
authors.forename: Nithya
authors.initials: N
authors.lastname: Kannan
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Richard B
authors.initials: RB
authors.lastname: Mink
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Giza
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Linda Ng
authors.initials: LN
authors.lastname: Boyle
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Mitchell
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000628:therapy*; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome