Isolated Head Injury Is a Cause of Shock in Pediatric Trauma Patients

Gardner, Alison; Poehling, Katherine A.; Miller, Chadwick D.; Tooze, Janet A.; Petty, John K.

doi:10.1097/pec.0b013e31829ec0ee

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…The interaction and effects of vasoactive agents (especially catecholamines) and fluid resuscitation on coagulation profiles, and optimal blood pressure in pediatric populations with isolated severe head injuries are also areas to be studied. 12,15,27 These investigations would require large prospective studies, possibly as part of a multicenter study or pediatric research network, given the relatively small numbers of severe head injuries in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Early coagulopathy in children with isolated blunt head injury is associated with mortality and poor neurological outcomes

James¹,

Chong²,

Shetty³

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVETraumatic brain injury (TBI) is the leading cause of long-term disability and death in children and adolescents globally. Long-term adverse outcomes, including physical, cognitive, and behavioral sequelae, have been reported after TBI in a significant number of pediatric patients. In this study the authors sought to investigate the epidemiology of TBI-associated coagulopathy and its association with mortality and poor neurological outcome in a pediatric population with isolated moderate to severe blunt head injury treated at the authors’ institution.METHODSThis retrospective study was conducted in the children’s emergency department between January 2010 and December 2016. Children < 18 years old who presented with isolated moderate to severe blunt head injury were included in the study. The authors collected data on patient demographics, clinical presentation, and TBI management. Outcomes studied were death and poor neurological outcome defined by a score of < 7 (death, moderate to severe neurological disability) at 6 months postinjury on the pediatric version of the Glasgow Outcome Scale–Extended (GOS-E Peds).RESULTSIn 155 pediatric patients who presented with isolated moderate to severe blunt head injury, early coagulopathy was observed in 33 (21.3%) patients during the initial blood investigations done in the emergency department. The mean (SD) age of the study group was 7.03 (5.08) years and the predominant mechanism of injury was fall from height (65.2%). The median Abbreviated Injury Scale of the head (AIS head) score was 4 and the median GCS score was 13 (IQR 12–15). TBI-associated coagulopathy was independently associated with GOS-E Peds score < 7 (p = 0.02, adjusted OR 6.07, 95% CI 1.32–27.83). The overall mortality rate was 5.8%. After adjusting for confounders, only AIS head score and hypotension at triage remained significantly associated with TBI-associated coagulopathy.CONCLUSIONSTBI-associated coagulopathy was independently associated with GOS-E Peds score < 7 at 6 months postinjury. Larger prospective studies are needed to investigate the use of TBI-associated coagulopathy to prognosticate these critical clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Early coagulopathy in children with isolated blunt head injury is associated with mortality and poor neurological outcomes

James¹,

Chong²,

Shetty³

et al. 2020

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

show abstract

“…There is a lack of information on the relationship between head injuries and unstable haemodynamic status; however, head injury as a cause of shock in paediatric patients has been reported previously. 22 Another study stated that the relationship between SI and haemorrhage is altered after an acute traumatic brain injury, and that the use of SI in the assessment of blood volume loss could be unreliable in these patients. 23 Thoracic and abdominal traumas, on the other hand, often result in massive haemorrhage, which subsequently leads to haemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system

Kuo

Hsu

et al. 2016

BMJ Open

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ObjectivesThe presentation of decrease blood pressure with tachycardia is usually an indicator of significant blood loss. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the haemodynamic status of trauma patients. As an SBP lower than the HR (RSI<1) may indicate haemodynamic instability, the objective of this study was to assess whether RSI<1 can help to identify high-risk patients with potential shock and poor outcome, even though these patients do not yet meet the criteria for multidisciplinary trauma team activation (TTA).DesignCross-sectional study.SettingTaiwan.ParticipantsWe retrospectively reviewed the data of 20 106 patients obtained from the trauma registry system of a level I trauma centre for trauma admissions from January 2009 through December 2014. Patients for whom a trauma team was not activated (regular patients) and who had RSI<1 were compared with regular patients with RSI≥1. The ORs of the associated conditions and injuries were calculated with 95% CIs.Main outcome measuresIn-hospital mortality.ResultsAmong regular patients with RSI<1, significantly more patients had an Injury Severity Score (ISS) ≥25 (OR 2.4, 95% CI 1.58 to 3.62; p<0.001) and the mortality rate was also higher (2.1% vs 0.5%; OR 3.9, 95% CI 2.10 to 7.08; p<0.001) than in regular patients with RSI≥1. The intensive care unit length of stay was longer in regular patients with RSI<1 than in regular patients with RSI≥1.ConclusionsAmong patients who did not reach the criteria for TTA, RSI<1 indicates a potentially worse outcome and a requirement for more attention and aggressive care in the emergency department.

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“…In trauma patients, the occurrence of haemorrhagic shock is associated with high mortality (as high as 50%) [7], and the reported incidence ranges from 6-16% [8]. These cases need to be differentiated from those in the paediatric population, where the isolated TBI can lead to severe shock (in the absence of apparent haemorrhage) [9,10]. Understanding the interaction of the simultaneous presence of TBI and haemorrhagic shock is essential to implement the optimal resuscitation strategy [11] and, thus, developing strategies to improve outcomes in this subgroup of patients [5].…”

Section: Introductionmentioning

confidence: 99%

Introductory Chapter: Concomitant Traumatic Brain Injury and Haemorrhagic Shock

Padala¹,

Waindeskar²,

Maurya³

et al. 2023

Management of Shock - Recent Advances

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Isolated Head Injury Is a Cause of Shock in Pediatric Trauma Patients

Abstract: Isolated head injury was observed in 29% of children 0 to 15 years of age with severe shock after trauma and in 50% of children younger than 5 years. Head injury is an important cause of severe shock in pediatric trauma, particularly among young children.

Cited by 6 publications

References 18 publications

Early coagulopathy in children with isolated blunt head injury is associated with mortality and poor neurological outcomes

Early coagulopathy in children with isolated blunt head injury is associated with mortality and poor neurological outcomes

The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system

Introductory Chapter: Concomitant Traumatic Brain Injury and Haemorrhagic Shock

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