In children who suffer out of hospital cardiac arrest, targeted hypothermia at 33.0 C confers no benefit when compared to targeted normothermia at 36.8 C. Level of evidence: 2B (RCT with wide CIs)Appraised by: Andrew Claxton Citation: Moler FW, Silverstein FS, Holubkov R and the THAPCA Trial Investigators. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Eng

BACKGROUND-Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after inhospital cardiac arrest are limited.

These results demonstrate that the addition of high doses of tamoxifen to this chemotherapy regimen does not increase the response rate compared with chemotherapy alone in unselected patients with metastatic melanoma.

Objective The Rotterdam computed tomography (CT) score refined features of the Marshall score and was designed to categorize traumatic brain injury (TBI) type and severity in adults. The objective of this study was to determine whether the Rotterdam CT score can be used for mortality risk stratification after pediatric TBI. Design In children with moderate to severe TBI, a comparison of observed versus predicted mortality calculated using published model probabilities of adult mortality. Development and validation of a new pediatric mortality model using randomly selected prediction and validation samples from our cohort. Setting A single level 1 pediatric trauma center. Subjects 632 children with moderate or severe TBI Interventions None. Measurements and Main Results Sixteen percent (101/632) of the patients died prior to hospital discharge. The predicted mortality based on Rotterdam score for adults with moderate or severe TBI discriminated pediatric observed mortality well (AUC = 0.85, 95% confidence interval [CI] 0.80 – 0.89) but had poor calibration, overestimating or underestimating mortality for children in several Rotterdam categories. A predictive model based on children with moderate or severe TBI from the single center discriminated mortality well (AUC 0.80, 95% CI 0.68 – 0.91) and showed good calibration and overall fit. Conclusions Children with TBI have better survival than adults in Rotterdam CT score categories representing less severe injuries, but worse survival than adults in higher score categories. A novel, validated pediatric mortality model based on the Rotterdam score is accurate in children with moderate or severe TBI and can be used for risk stratification.