Hyperglycemia and Outcomes from Pediatric Traumatic Brain Injury

Cochran, Amalia; Scaife, Eric R.; Hansen, Kristine; Downey, Earl C.

doi:10.1097/01.ta.0000031175.96507.48

Cited by 190 publications

(114 citation statements)

References 12 publications

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“…Other studies in children with traumatic brain or head injury have also shown an association between poor neurological outcome and elevated admission blood glucose. 24,[26][27][28] Brain trauma patients with permanent neurological deficits and in a vegetative state were found to have significantly higher admission blood glucose concentrations than children with good neurological recovery or minimal deficits. In addition, the development of inpatient hyperglycemia in children with extensive burn injuries, covering more than 60% of total body surface area, was found to increase the risk of bacteremia and fungemia, reduce skin graft adhesion, and increase the mortality rate.…”

Section: Discussionmentioning

confidence: 96%

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.METHODS:The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non–critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.RESULTS:A total of 406 patients (75%) had an admission blood glucose ≤120 mg/dL (mean ± SEM 98 ± 1 mg/dL), 103 children (19%) had an admission blood glucose level of 121–179 mg/dL (mean 143 ± 2 mg/dL), and 32 patients (5.9%) had a blood glucose level ≥180 mg/dL (mean 260 ± 18 mg/dL). Seventeen patients (13%) had a known history of diabetes prior to admission. Children with hyperglycemia were more likely to be admitted to the ICU (P < .001) and had a longer length of ICU stay (P < .001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality.CONCLUSIONS:Hyperglycemia is present in one‐fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in‐hospital mortality. Journal of Hospital Medicine 2008;3:212–217. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 96%

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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“…Large prospective randomized clinical trails are essential to compare the efficacy of different strategies [32,37,38,39,40]. These are not easy to perform in children with severe TBI since the number of children treated at each center is low.…”

Section: Discussionmentioning

confidence: 99%

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A twocenter retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.

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“…1,29 Several studies have demonstrated the association of SH in critically ill children with mortality. [1][2][3][4][5][10][11][12][13][14][15][16] Specifically, peak and duration of SH appear to be associated with mortality. Peak BG concentrations tend to be much higher in nonsurvivors compared with survivors.…”

Section: Stress Hyperglycemia In Pediatric Critical Illnessmentioning

confidence: 99%

“…8,9 However, studies in children have challenged this assertion by observing that SH during critical illness is associated with poor outcomes. [1][2][3][4][5][6][7][10][11][12][13][14][15][16] Based on the premise that SH during critical illness is possibly harmful, tight glucose control (TGC) to normalize blood glucose (BG) concentrations has emerged as a rational but unproven therapy to improve outcomes in critically ill children. Studies of TGC in critically ill adults have had mixed results, with some observing worse outcomes from TGC.…”

Section: Introductionmentioning

confidence: 99%

Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

Srinivasan

2012

J Diabetes Sci Technol

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Abbreviations: (BG), blood glucose, (CBP) cardiopulmonary bypass, (EN) enteral nutrition, (ECLS) extracorporeal life support, (FFA) free fatty acids, (GIR) glucose infusion rate, (GLUT) glucose transporter protein, (GH) growth hormone, (IGF-1) insulin-like growth factor-1, (ICU) intensive care unit, (IL-1) interleukin-1, (IL-6) interleukin-6, (PN) parenteral nutrition, (ROS) reactive oxygen species, (RRT) renal replacement therapy, (SH) stress hyperglycemia, (TGC) tight glucose control, (TNF-α) tumor necrosis factor-α

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Hyperglycemia and Outcomes from Pediatric Traumatic Brain Injury

Cited by 190 publications

References 12 publications

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

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