Journal article
Age and Mortality in Pediatric Severe Traumatic Brain Injury: Results from an International Study
Neurocritical care, Vol.28(3), pp.302-313
06/2018
DOI: 10.1007/s12028-017-0480-x
PMID: 29476389
Abstract
Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study.The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score ≤ 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5–< 11, 11–18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan–Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates.In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts.In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury—unrelated to AHT—that may lead to testable hypotheses in the future.
Details
- Title: Subtitle
- Age and Mortality in Pediatric Severe Traumatic Brain Injury: Results from an International Study
- Creators
- Ajit Sarnaik - 0000 0001 1456 7807 grid.254444.7 Departments of Pediatrics Wayne State University Detroit MI USANikki Ferguson - 0000 0004 0458 8737 grid.224260.0 Departments of Pediatrics Virginia Commonwealth University Richmond VA USAA M O’Meara - 0000 0004 0458 8737 grid.224260.0 Departments of Pediatrics Virginia Commonwealth University Richmond VA USAShruti Agrawal - 0000 0004 0622 5016 grid.120073.7 Departments of Pediatrics Addenbrookes Hospital Cambridge UKAkash Deep - 0000 0004 0391 9020 grid.46699.34 Departments of Pediatrics Kings College Hospital London UKSandra Buttram - 0000 0001 0381 0779 grid.417276.1 Departments of Pediatrics Phoenix Children’s Hospital Phoenix AZ USAMichael Bell - 0000 0004 1936 9000 grid.21925.3d Critical Care Medicine, Neurological Surgery and Pediatrics University of Pittsburgh 3434 Fifth Avenue Pittsburgh PA 15260 USAStephen Wisniewski - 0000 0004 1936 9000 grid.21925.3d Departments of Epidemiology University of Pittsburgh Pittsburgh PA USAJames Luther - 0000 0004 1936 9000 grid.21925.3d Departments of Epidemiology University of Pittsburgh Pittsburgh PA USAAdam Hartman - 0000 0001 2177 357X grid.416870.c The Office of Clinical Research National Institute of Neurological Disorders and Stroke Bethesda MD USAMonica Vavilala - 0000000122986657 grid.34477.33 Departments of Anesthesiology and Pain Medicine University of Washington Seattle WA USAInvestigators of the ADAPT Trial
- Contributors
- Elizabeth A Newell (Contributor) - University of Iowa, Stead Family Department of Pediatrics
- Resource Type
- Journal article
- Publication Details
- Neurocritical care, Vol.28(3), pp.302-313
- DOI
- 10.1007/s12028-017-0480-x
- PMID
- 29476389
- NLM abbreviation
- Neurocrit Care
- ISSN
- 1541-6933
- eISSN
- 1556-0961
- Publisher
- Springer US; New York
- Grant note
- NS081041 / National Institute of Neurological Disorders and Stroke
- Language
- English
- Date published
- 06/2018
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics; Iowa Neuroscience Institute
- Record Identifier
- 9984070586302771
Metrics
20 Record Views