Prognostic implications of hyperglycaemia in paediatric head injury

Chiaretti, Antonio; Benedictis, R De; Langer, A.; Rocco, C. Di; Bizzarri, Carla; Iannelli, Aldo; Polidori, Giancarlo

doi:10.1007/s003810050259

Cited by 53 publications

(47 citation statements)

References 15 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: 97%

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: 97%

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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“…Even though many markers associated with neuronal and glial injury, hypoxia, and inflammation have been studied, currently there is no reliable and practical biochemical marker of head injury 5,11,26,28) . Only two markers seem to have a diagnostic adjunct in adults : neuron-specific enolase (NSE) and S100B protein 5,7,10,13,14,17,28,[34][35][36] .…”

Section: Proposal For a Panel Of Biomarkers Including Serum Osmolaritmentioning

confidence: 99%

Does Serum Osmolarity Change as a Result of the Reflex Neuroprotective Mechanism of Cerebral Osmo-Regulation after Minor Head Trauma?

Balak

Işıksaçan

Türkoğlu

2009

J Korean Neurosurg Soc

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Objective : It is well known that changes in cerebral hemodynamics occur after traumatic brain injury (TBI). Osmo-regulation in the brain is important for maintaining a constant milieu in the central nervous system. Nevertheless, to our knowledge, early osmolarity changes after minor head injury have not been studied until now. Methods : In this study, serum osmolarity was measured in 99 patients with minor head trauma. As a control group, blood samples were drawn from 99 patients who had a minor trauma in an extremity. Serum osmolarity was estimated using a fully automatic biochemical autoanalyzer within the first 3 hours after the trauma. Results : The mean serum osmolarity levels were 286.08±10.17 mOsm/L in the study group and 290.94±5.65 mOsm/L in the control group (p<0.001). However, after age adjustment between the study and control groups, this statistical significance was found to be valid only for patients over 30 years of age. Conclusion : It was noted that serum osmolarity levels decrease in the first 3 hours following minor head trauma in patients over 30 years of age. Further studies into this area could provide guidance for the management/treatment of elderly patients

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“…However, high blood glucose is common in acutely ill neurological patients, even in non-diabetics ones. A consensus regarding the cut-off blood glucose level that would be related to a poor prognosis in children and adolescents with head trauma is still lacking, which makes the comparison of different studies particularly troublesome [3][4][5][6][7][8][9] .…”

mentioning

confidence: 99%

“…Some authors believe that patients with hyperglycemia generally have a low Glasgow Coma Scale (GCS) score [3][4][5][6] , poor neurological prognosis (based on GCS) and a history of severe trauma with significant brain injury 6,7 . It is well known that such acute hyperglycemia is a result of catecholamine' effects 8,9 .…”

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confidence: 99%

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Melo

Reis²,

Lemos-Júnior³

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS). Method: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. Results: A total of 340 children were included and 60 (17.6%) had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans. Conclusion: Hyperglycemia was more prevalent in patients with severe head trauma (GCS ≤8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.Key WordS: adolescents, children, head trauma, hyperglycemia, prevalence. Hiperglicemia em pacientes pediátricos com traumatismo craniencefálico: estudo de corte transversalResumo -Objetivo: Verificar a prevalência de hiperglicemia aguda em crianças vítimas de trauma craniencefálico, de acordo com a escala de coma de Glasgow (GCS). Método: estudo prospectivo, de corte transversal realizado por meio do acompanhamento de prontuários médicos de pacientes na faixa etária pediátrica admitidos na unidade de urgência de um hospital de referência vítimas de traumatismo craniencefálico, durante um ano. Consideramos o valor de corte em 150 mg/dL para definição de hiperglicemia. Resultados: 340 crianças foram incluídas no estudo e 60 (17,6%) apresentaram hiperglicemia na admissão. Hiperglicemia esteve presente em 9% dos casos de trauma craniano leve, 30,4% daqueles com trauma craniano moderado e em 49% dos pacientes com trauma craniano grave. Verificamos que, entre as crianças com níveis elevados de glicemia, 85% apresentavam alterações radiológicas verificadas na tomografia computadorizada do crânio. Conclusão: A hiperglicemia foi mais prevalente em pacientes com traumatismo craniano grave (GCS ≤8), assim como naqueles com alterações identificadas na tomografia computadorizada do crânio, independente da presença de politraumatismo.

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Prognostic implications of hyperglycaemia in paediatric head injury

Cited by 53 publications

References 15 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

Does Serum Osmolarity Change as a Result of the Reflex Neuroprotective Mechanism of Cerebral Osmo-Regulation after Minor Head Trauma?

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

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