Prognostic factors of acute neurological outcomes in infants with traumatic brain injury
The purpose of this study is to clarify risk factors for poor neurological outcomes and distinctive characteristics in infants with traumatic brain injury.
The study retrospectively reviewed data of 166 infants with traumatic intracranial hemorrhage from three tertiary institutions in Japan between 2002 and 2013. Univariate and multivariate analyses were used to identify clinical symptoms, vital signs, physical findings, and computed tomography findings associated with poor neurological outcomes at discharge from the intensive care unit.
In univariate analysis, bradypnea, tachycardia, hypotension, dyscoria, retinal hemorrhage, subdural hematoma, cerebral edema, and a Glasgow Coma Scale (GCS) score of ≤ 12 were significantly associated with poor neurological outcomes (P < 0.05). In multivariate analysis, a GCS score of ≤ 12 (OR = 130.7; 95% CI, 7.3–2323.2; P < 0.001), cerebral edema (OR = 109.1; 95% CI, 7.2–1664.1; P < 0.001), retinal hemorrhage (OR = 7.2; 95% CI, 1.2–42.1; P = 0.027), and Pediatric Index of Mortality 2 score (OR = 1.6; 95% CI, 1.1–2.3; P = 0.018) were independently associated with poor neurological outcomes. Incidence of bradypnea in infants with a GCS score of ≤ 12 (25/42) was significantly higher than that in infants with GCS score of > 12 (27/90) (P = 0.001).
Infants with a GCS score of ≤ 12 are likely to have respiratory disorders associated with traumatic brain injury. Physiological disorders may easily lead to secondary brain injury, resulting in poor neurological outcomes. Secondary brain injury should be prevented through early interventions based on vital signs and the GCS score.
KeywordsInfant Traumatic brain injury Glasgow Coma Scale Secondary brain injury
Compliance with ethical standards
The Ethical Board of Nagano Children’s Hospital approved this retrospective study (Receipt number 27-57).
Conflict of interest
The authors declare that they have no conflicts of interest.
- 2.MRC CRASH Trial Collaborators, Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S, Roberts I, Shakur H, Steyerberg E, Yutthakasemsunt S (2008) Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 336(7641):425–429. https://doi.org/10.1136/bmj.39461.643438.25 CrossRefPubMedCentralGoogle Scholar
- 3.Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, Murray GD, Marmarou A, Roberts I, Habbema JD, Maas AI (2008) Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med 5(8, discussion e165):e165. https://doi.org/10.1371/journal.pmed.0050165 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Tude Melo JR, Di Rocco F, Blanot S, Oliveira-Filho J, Roujeau T, Sainte-Rose C, Duracher C, Vecchione A, Meyer P, Zerah M (2010) Mortality in children with severe head trauma: predictive factors and proposal for a new predictive scale. Neurosurgery 67(6):1542–1547. https://doi.org/10.1227/NEU.0b013e3181fa7049 CrossRefGoogle Scholar
- 12.Chung CY, Chen CL, Cheng PT, See LC, Tang SF, Wong AM (2006) Critical score of Glasgow Coma Scale for pediatric traumatic brain injury. Pediatr Neurol 34(5):379–387. https://doi.org/10.1016/j.pediatrneurol.2005.10.012 CrossRefPubMedGoogle Scholar
- 17.Ducrocq SC, Meyer PG, Orliaguet GA, Blanot S, Laurent-Vannier A, Renier D, Carli PA (2006) Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatr Crit Care Med 7(5):461–467. https://doi.org/10.1097/01.PCC.0000235245.49129.27 CrossRefPubMedGoogle Scholar
- 20.Hackbarth RM, Rzeszutko KM, Sturm G, Donders J, Kuldanek AS, Sanfilippo DJ (2002) Survival and functional outcome in pediatric traumatic brain injury: a retrospective review and analysis of predictive factors. Crit Care Med 30(7):1630–1635. https://doi.org/10.1097/00003246-200207000-00038 CrossRefPubMedGoogle Scholar
- 22.Jagannathan J, Okonkwo DO, Yeoh HK, Dumont AS, Saulle D, Haizlip J, Barth JT, Jane JA Sr, Jane JA Jr (2008) Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure. J Neurosurg Pediatr 2(4):240–249. https://doi.org/10.3171/PED.2008.2.10.240 CrossRefPubMedGoogle Scholar
- 24.Keenan HT, Bratton SL (2006) Epidemiology and outcomes of pediatric traumatic brain injury. Dev Neurol 28:256–263Google Scholar
- 30.Fleming S, Thompson M, Stevens R, Heneghan C, Plüddemann A, Maconochie I, Tarassenko L, Mant D (2011) Normal ranges of heart rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 377(9770):1011–1018. https://doi.org/10.1016/S0140-6736(10)62226-X CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Dunham CM, Barraco RD, Clark DE, Daley BJ, Davis FE 3rd, Gibbs MA, Knuth T, Letarte PB, Luchette FA, Omert L, Weireter LJ, Wiles CE 3rd, EAST Practice Management Guidelines Work Group (2003) Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma 55:162–179CrossRefPubMedGoogle Scholar
- 42.Kemp AM, Jaspan T, Griffirhs J, Stoodley N, Mann MK, Tempest V, Maguire SA (2011) Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Arch Dis Child 96(12):1103–1112. https://doi.org/10.1136/archdischild-2011-300630 CrossRefPubMedGoogle Scholar