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Prognostic factors of acute neurological outcomes in infants with traumatic brain injury

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Abstract

Purpose

The purpose of this study is to clarify risk factors for poor neurological outcomes and distinctive characteristics in infants with traumatic brain injury.

Methods

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.

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Department of Pediatric Intensive Care, Nagano Children’s Hospital, 3100, Toyoshina, Azumino City, Nagano, 399-8288, Japan

    Shunsuke Amagasa & Hikoro Matsui

  2. Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan

    Shunsuke Amagasa & Takashi Moriya

  3. Department of Emergency Medicine and Transport Service, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Satoshi Tsuji & Satoko Uematsu

  4. Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1, Oyaguchikamichou, Itabashi-ku, Tokyo, 173-8610, Japan

    Kosaku Kinoshita

Authors
  1. Shunsuke Amagasa
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  2. Satoshi Tsuji
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  3. Hikoro Matsui
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  4. Satoko Uematsu
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  5. Takashi Moriya
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Correspondence to Shunsuke Amagasa.

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Ethical approval

The Ethical Board of Nagano Children’s Hospital approved this retrospective study (Receipt number 27-57).

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The authors declare that they have no conflicts of interest.

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Amagasa, S., Tsuji, S., Matsui, H. et al. Prognostic factors of acute neurological outcomes in infants with traumatic brain injury. Childs Nerv Syst 34, 673–680 (2018). https://doi.org/10.1007/s00381-017-3695-4

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  • DOI: https://doi.org/10.1007/s00381-017-3695-4

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