Acta Neurochirurgica

, Volume 152, Issue 9, pp 1559–1565

Acute hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

Authors

    • Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France)Université Descartes Paris 5
    • Post-Graduate Program in Medicine and Health, School of MedicineFederal University of Bahia
  • Federico Di Rocco
    • Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France)Université Descartes Paris 5
  • Stéphane Blanot
    • Pediatric Surgical Critical Care Unit, and Anesthesiology, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France)Université Descartes Paris 5
  • Anne Laurent-Vannier
    • Hôpital National de Rehabilitation de Saint Maurice
  • Rodolfo Casimiro Reis
    • Post-Graduate Program in Medicine and Health, School of MedicineFederal University of Bahia
  • Thomas Baugnon
    • Pediatric Surgical Critical Care Unit, and Anesthesiology, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France)Université Descartes Paris 5
  • Christian Sainte-Rose
    • Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France)Université Descartes Paris 5
  • Jamary Olveira-Filho
    • Post-Graduate Program in Medicine and Health, School of MedicineFederal University of Bahia
  • Michel Zerah
    • Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France)Université Descartes Paris 5
  • Philippe Meyer
    • Pediatric Surgical Critical Care Unit, and Anesthesiology, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France)Université Descartes Paris 5
Clinical Article

DOI: 10.1007/s00701-010-0680-z

Cite this article as:
Melo, J.R.T., Di Rocco, F., Blanot, S. et al. Acta Neurochir (2010) 152: 1559. doi:10.1007/s00701-010-0680-z

Abstract

Purpose

Hyperglycemia in the acute phase after trauma could adversely affect outcome in children with severe traumatic brain injury (TBI). The goal of this study was to identify the relationship between acute spontaneous hyperglycemia and outcome in children with severe TBI at hospital discharge and 6 months later.

Methods

A retrospective analysis of blood glucose levels in children with severe TBI at a Pediatric level I Trauma Center, between January 2000 and December 2005. Hyperglycemia was considered for a cut-off value of 11.1 mmol/l (200 mg/dl). Outcome was measured with Glasgow Outcome Scale (GOS) at hospital discharge and at 6 months. A multiple logistic regression analysis, the Student's t test and the χ2 test were done.

Results

Hyperglycemia was noted within the first 48 h in 34% of the patients. Mortality (70% vs 14%, p < 10-5) was more frequent in hyperglycemic children and bad outcome upon hospital discharge in those who remained hyperglycemic during the first 48 h of hospitalization. GOS after 6 months demonstrated that those normoglycemic children had a better outcome (95%) than those who developed hyperglycemia during the first 48 h (83%, p = 0.01) after trauma.

Conclusion

Hyperglycemia could be considered as a marker of brain injury and when present upon admission, could reflect extensive brain damage with frequently associated mortality and bad outcome. The inability to maintain normal blood glucose levels during the first 48 h could be a predictive factor of bad outcome. Avoiding hyperglycemia in the initial phase could be a major issue in children with severe TBI.

Keywords

PediatricHead injuryHyperglycemiaPrognosisOutcome

Copyright information

© Springer-Verlag 2010