The role of serious concomitant injuries in the treatment and outcome of pediatric severe traumatic brain injury

Stewart, Tanya Charyk; Alharfi, Ibrahim M.; Fraser, Douglas D.

doi:10.1097/ta.0b013e3182a685b0

Cited by 48 publications

(24 citation statements)

References 18 publications

(29 reference statements)

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“…Focusing on other possible prognostic factors following pediatric TBI, we also found that the median PTS was significantly associated with mortality ( Table 1 ). A previous report of 180 patients [ 33 ] demonstrated that patients with serious concomitant injuries had fewer days off mechanical ventilation and longer hospital stay, although it did not significantly predict for mortality. In the above study, patients with serious concomitant injuries were most likely involved in motor vehicle accidents and had more severe TBI [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…A previous report of 180 patients [ 33 ] demonstrated that patients with serious concomitant injuries had fewer days off mechanical ventilation and longer hospital stay, although it did not significantly predict for mortality. In the above study, patients with serious concomitant injuries were most likely involved in motor vehicle accidents and had more severe TBI [ 33 ]. In another study of 100 adults with TBI, high grade concomitant injuries were associated with functional disability 18 months after the injury [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay

Chong

Harjanto

Testoni

et al. 2015

International Journal of Endocrinology

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We aim to study the association between hyperglycemia and in-hospital outcomes among children with moderate and severe traumatic brain injury (TBI). This retrospective cohort study was conducted in a tertiary pediatric hospital between 2003 and 2013. All patients < 16 years old who presented to the Emergency Department within 24 hours of head injury with a Glasgow Coma Scale (GCS) ≤ 13 were included. Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days. Hyperglycemia was defined as glucose > 200 mg/dL (11.1 mmol/L). Among the 44 patients analyzed, the median age was 8.6 years (interquartile range (IQR) 5.0–11.0). Median GCS and pediatric trauma scores were 7 (IQR 4–10) and 4 (IQR 3–6), respectively. Initial hyperglycemia was associated with death (37% in the hyperglycemia group versus 8% in the normoglycemia group, p = 0.019), reduced median PICU-free days (6 days versus 11 days, p = 0.006), and reduced median ventilation-free days (8 days versus 12 days, p = 0.008). This association was however not significant in the stratified analysis of patients with GCS ≤ 8. Conclusion. Our findings demonstrate that early hyperglycemia is associated with increased mortality, prolonged duration of mechanical ventilation, and PICU stay in children with TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay

Chong

Harjanto

Testoni

et al. 2015

International Journal of Endocrinology

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“…18 A comprehensive workup should be performed to look for associated injuries, particularly closed head injury. Traumatic brain injury is a major cause of morbidity and mortality in the pediatric and adolescent polytrauma population, 19 and the utilization of flexible nailing must be performed with caution to prevent pulmonary and neurological compromise. 18 Additional orthopaedic injuries should be sought out and treated as well.…”

Section: Initial Assessmentmentioning

confidence: 99%

Flexible Intramedullary Nailing of Unstable and/or Open Tibia Shaft Fractures in the Pediatric Population

Pandya

2016

Journal of Pediatric Orthopaedics

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Tibial shaft fractures are common injuries in the pediatric population, and can be treated conservatively the vast majority of the time. Yet, it is important to recognize that open and/or unstable tibial shaft fractures represent a different entity. Rigid intramedullary devices are generally contraindicated because of the skeletal immaturity of these patients, and external fixation is associated with a high complication rate. As a result, flexible nailing is being utilized with increasing frequency. It is essential for the clinician to understand the pearls and pitfalls associated with the utilization of these flexible nails; particularly in regards to their immediate use in the context of open fractures and the risk of compartment syndrome postoperatively after fixation.

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“…Patients were included in the study if the following criteria were met: Diagnosis of sTBI by computed tomography or magnetic resonance imaging; Glasgow Coma Scale (GCS) score of <8; and admittance to ICU within 8 h after injury (6). Exclusion criteria included combined brain complications, combined severe injury and patient mortality within seven days following injury (7).…”

Section: Methodsmentioning

confidence: 99%

Effects of ulinastatin on cerebral oxygen metabolism and CRP levels in patients with severe traumatic brain injury

Liu

Shen

Chang

et al. 2014

Experimental and Therapeutic Medicine

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The aim of the present study was to investigate the effects of ulinastatin on cerebral oxygen metabolism and C-reactive protein (CRP) levels in patients with severe traumatic brain injury (sTBI). A total of 92 patients with sTBI, admitted to the First Affiliated Hospital of Xinxiang Medical University (Xinxiang, China), were randomly divided into control and observation groups. The control group received conventional therapy plus a placebo (0.9% sodium chloride), while the observation group were administered conventional therapy plus 200,000 units ulinastatin via intravenous injection twice a day for seven days. Arterial and jugular venous blood was collected for blood gas analysis. The jugular venous blood lactate (JVBL), jugular venous bulb oxygen saturation (SjvO2), arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2) levels were measured on day 1, 3, 5 and 7, as well as the level of CRP in the peripheral blood. In the control group, the level of JVBL decreased as compared with the level at day 1, however, no statistically significant differences were observed (P>0.05). By contrast, the observation group exhibited a significant reduction in the level of JVBL (P<0.05), which was also significantly lower compared with the control group (P<0.05). Statistically significant differences were observed between the two groups with regard to SjvO2, AVDO2 and CEO2 on day 3, 5 and 7. The CRP levels in the two groups increased and peaked on day 3. However, the CRP level in the observation group significantly decreased on day 5 (35.27±15.18 mg/l) and day 7 (22.65±10.48 mg/l), which was lower compared with the control group (56.19±13.24 mg/l and 47.36±15.73 mg/l, respectively); statistically significant differences were observed (P<0.05). Therefore, ulinastatin effectively improved cerebral oxygen metabolism and reduced the CRP level in patients with sTBI.

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The role of serious concomitant injuries in the treatment and outcome of pediatric severe traumatic brain injury

Abstract: Prognostic and epidemiologic study, level III.

Cited by 48 publications

References 18 publications

Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay

Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay

Flexible Intramedullary Nailing of Unstable and/or Open Tibia Shaft Fractures in the Pediatric Population

Effects of ulinastatin on cerebral oxygen metabolism and CRP levels in patients with severe traumatic brain injury

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