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The frequency of cerebral ischemia/hypoxia in pediatric severe traumatic brain injury

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Abstract

Introduction

The frequency of adverse events, such as cerebral ischemia, following traumatic brain injury (TBI) is often debated. Point-in-time monitoring modalities provide important information, but have limited temporal resolution.

Purpose

This study examines the frequency of an adverse event as a point prevalence at 24 and 72 h post-injury, compared with the cumulative burden measured as a frequency of the event over the full duration of monitoring.

Methods

Reduced brain tissue oxygenation (PbtO2 < 10 mmHg) was the adverse event chosen for examination. Data from 100 consecutive children with severe TBI who received PbtO2 monitoring were retrospectively examined, with data from 87 children found suitable for analysis. Hourly recordings were used to identify episodes of PbtO2 less than 10 mmHg, at 24 and 72 h post-injury, and for the full duration of monitoring.

Results

Reduced PbtO2 was more common early than late after injury. The point prevalence of reduced PbtO2 at the selected time points was relatively low (10 % of patients at 24 h and no patients at the 72-h mark post-injury). The cumulative burden of these events over the full duration of monitoring was relatively high: 50 % of patients had episodes of PbtO2 less than 10 mmHg and 88 % had PbtO2 less than 20 mmHg.

Conclusion

Point-in-time monitoring in a dynamic condition like TBI may underestimate the overall frequency of adverse events, like reduced PbtO2, particularly when compared with continuous monitoring, which also has limitations, but provides a dynamic assessment over a longer time period.

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Authors and Affiliations

  1. Pediatric Neurosurgery, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Rondebosch, 8001, Cape Town, South Africa

    Llewellyn C. Padayachy, Ursula Rohlwink, Graham Fieggen, Jonathan C. Peter & Anthony A. Figaji

  2. Biostatistics Department, University of Swaziland, Mbabane, Swaziland

    Eugene Zwane

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  1. Llewellyn C. Padayachy
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  2. Ursula Rohlwink
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  3. Eugene Zwane
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  4. Graham Fieggen
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  5. Jonathan C. Peter
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  6. Anthony A. Figaji
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Correspondence to Llewellyn C. Padayachy.

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Padayachy, L.C., Rohlwink, U., Zwane, E. et al. The frequency of cerebral ischemia/hypoxia in pediatric severe traumatic brain injury. Childs Nerv Syst 28, 1911–1918 (2012). https://doi.org/10.1007/s00381-012-1837-2

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  • DOI: https://doi.org/10.1007/s00381-012-1837-2

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