Traumatic brain injury in childhood: Intensive Care time series data and outcome

Abstract

Age-specific norms are necessary to determine potential secondary brain insult after head injury in children. We describe and quantify the secondary physiological derangement recorded in children of different ages following traumatic brain injury, and relate it to outcome at 12 months post-injury. Prospective time-series data (including intracranial pressure, arterial blood pressure, cerebral perfusion pressure, oxygen saturation, temperature and heart rate) downloaded from ICU monitors, were examined to identify abnormal (i.e. outside normal age-specific limits) recordings lasting more than 5 min. Cumulated total duration of derangement was calculated for each parameter and as a percentage of the time that the ICP monitor was in situ. Univariate and multivariate logistic regression modelling was used to evaluate predictors of outcome. Age-specificity allows realistic comparisons of physiological data among children. Duration of age-specific derangement of CPP was found to predict outcome (dead v. alive: p = 0.003 and Glasgow Outcome Score 1–3 v. 4–5, i.e. poor v. independent outcome p = 0.004).

Key Words:

• Age-specific physiological derangements
• cerebral perfusion pressure
• children
• intracranial pressure
• outcome
• secondary insults
• traumatic brain injury