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A Retrospective Cohort Study of Traumatic Brain Injury in Children: A Single-Institution Experience and Determinants of Neurologic Outcome Cover

A Retrospective Cohort Study of Traumatic Brain Injury in Children: A Single-Institution Experience and Determinants of Neurologic Outcome

The Journal of Critical Care Medicine
Volume 9 (2023): Issue 4 (October 2023)
By: ,  ,  ,  ,  ,  ,  ,  ,   and    
Open Access
|Nov 2023
Figures & tables

Figures & Tables

Fig. 1.

Distribution of trauma cases by hours of the day in TBI patients

Fig. 2.

Distribution of trauma cases by months of the year in TBI patients

Fig. 3.

Etiology of TBI in different age groups

Table 1.

The causes, locations, and clinical features of traumatic brain injury in 90 children

Causesn%Locationsn%
Road traffic accidents3943.3Outdoor6774.4
Passenger1213.3Home2123.3
Pedestrian2730School22.2
Fall from height3437.8CT/MRI findingsn%
Cyclist910Skull fracture5864.4
Falling object44.4Brain edema4448.9
Basic fall33.3Subdural hemorrhage1921.1
Other11.1Epidural hemorrhage1415.6
Sign and symptomsn%Intraparenchymal hemorrhage1314.4
Altered consciousness5965.6Brain contusion1011.1
Nausea/Vomiting2831.1Subarachnoid hemorrhage910
Seizure1617.8Diffuse axonal injury55.6
Headache910Minimal brain edema55.6
Amnesia22.2
Asymptomatic66.7

[i] CT; computerized tomography, MRI; magnetic resonance imaging, TBI; traumatic brain injury

Table 2.

Comparison of demographic and clinical parameters between patients according to the presence of early, and late enteral feeding

<48th hour of hospitalization (n=65)>48th hour of hospitalization (n=25)p
Age (year), median5.08 (0.25–17.5)7.58 (0.67–17.5)0.063
Gender (female)25 (38.5)12 (48)0.410
Trauma localization
Multisystemic trauma32 (49.2)24 (96)0.001
Extremity trauma11 (16.9)15 (60)0.001
Pelvic trauma1 (1.5)7 (28)0.001
Thorax trauma20 (30.8)10 (40)0.405
Abdominal trauma8 (12.3)13 (52)0.001
Facial trauma11 (16.9)12 (48)0.002
Vertebral trauma4 (6.2)4 (16)0.142
CT/MRI findings
Skull fracture40 (61.5)18 (72)0.353
Brain contusion7 (10.8)3 (12)0.868
Subarachnoid hemorrhage5 (7.7)4 (16)0.239
Subdural hemorrhage15 (23.1)4 (16)0.461
Epidural hemorrhage11(16.9)3 (12)0.564
Intraparenchymal hemorrhage10 (15.4)3 (12)0.682
Brain edema31 (47.7)13 (52)0.714
Diffuse axonal injury5 (7.7)00.067
First 24 hours
Blood products19 (29.2)13 (52)0.043
Cranial surgery8 (12.3)2 (8)0.560
Other surgery6 (9.2)11 (44)0.001
CPR1 (1.5)2 (8)0.128
Mechanical ventilation11 (16.9)5(20)0.732
Nosocomial infection10 (15.4)4 (16)0.943
PICU stay3 (1–28)5 (1–47)0.272
Length of hospitalization5 (2–43)10 (5–60)0.001
Table 3.

Comparison of different scoring systems of the TBI patients according to the presence of early, and late enteral feeding

ParameterEnteral feedingp
<48th hour of hospitalization (n=65)>48th hour of hospitalization (n=25)
PRISM5 (0–25)6 (1–27)0.124
PDR (%)1.6 (0.5–59)2.1 (0.4–52.8)0.296
PIM32 (0.7–27)2.2 (0.9–11)0.182
Pediatric Trauma Score10 (−1–12)9 (1–12)0.139
Injury severity score5 (1–50)10 (2–41)0.001
GCS13 (2–15)13 (5–15)0.985
GOS at discharge5 (1–5)5 (3–5)0.340
GOS at 3rd month5 (1–5)5 (3–5)0.238
Favorable GOS at discharge46 (70.8)15 (60)0.327
Favorable GOS at 3rd month50 (76.9)16 (64)0.214

[i] PRISM; The Pediatric Risk of Mortality score, PDR; predicted death rate, PIM3; The Pediatric Index of Mortality 3, GCS; Glasgow coma scale, GOS: Glasgow outcome score

Table 4.

Comparison of demographic and clinical properties between patients with favorable outcome and disability according to Glasgow Outcome Score (GOS) 3 months after TBI

ParameterGOS at 3rd monthp
GOS=5 (n=66)GOS≤4 (n=24)
Age4.9 (0.3–17.5)6.1 (0.2–17.5)0.942
Gender (female)29 (43.9)8 (33.3)0.366
Multisystemic trauma37 (56.1)19 (79.2)0.046
Trauma localization in multisystemic trauma
Extremity trauma20 (30.3)6 (25)0.624
Pelvic trauma6 (9.1)2 (8.3)0.911
Thorax trauma14 (21.2)16 (66.7)0.001
Abdominal trauma12 (18.2)9 (37.5)0.054
Facial trauma17 (25.8)6 (25)0.942
Vertebral trauma7 (10.6)1 (4.2)0.342
Altered consciousness37 (56.1)22 (91.7)0.002
Seizure5 (7.6)11 (45.8)0.001
CT/MRI findings
Skull fracture46 (69.7)12 (50)0.084
Brain contusion26 (39.4)23 (95.8)0.001
Subarachnoid hemorrhage4 (6.1)5 (20.8)0.039
Subdural hemorrhage9 (13.6)10 (41.7)0.004
Epidural hemorrhage9 (13.6)5 (20.8)0.405
Intraparenchymal hemorrhage7 (10.6)6 (25)0.086
Brain edema31 (47)13 (54.2)0.546
Diffuse axonal injury05 (28)0.001
Shock treatment in ED5 (7.6)5 (20.8)0.077
Inotropic drug in ED1 (1.5)3 (12.5)0.025
Blood products in 48 h16 (24.2)16 (66.7)0.001
Cranial surgery in 24 h4 (6.1)6 (25)0.011
Other surgery in 24 h11 (16.7)6 (25)0.372
CPR in the first 24h of hospitalization03 (12.5)0.003
MV in the first 24h of hospitalization1 (1.5)15 (62.5)0.001
Nosocomial infections2 (3)12 (50)0.001
PICU stay2 (1–12)9 (2–47)0.001
Length of hospitalization5 (2–33)16.5 (6–60)0.001
MV duration1 (1–4)5 (1–28)0.061
PRISM4 (0–18)16 (4–27)0.001
PDR (%)1.5 (0.4–25.5)15.5 (0–59)0.001
PIM31.8 (0.7–8)6.8 (1.2–27)0.001
Pediatric Trauma score (PTS)10 (6–12)5 (−1–11)0.001
Injury severity score (ISS)5 (1–24)15 (4–50)0.001
GCS at admission15 (2–15)8 (4–15)0.001
Table 5.

Multiple logistic regression analysis of variables associated with outcome according to the 3rd month GOS in traumatic brain injury patients

VariablesBS.E.POR (95% CI)
Diffuse axonal injury−0.2810.2430.0012.62 (1.83–3.74)
CPR in the first 24h of hospitalization−0.3390.5030.0051.62 (1.13–2.74)
PIM3−0.2850.0230.0231.56 (0.40–6.19)

[i] GOS; Glasgow Outcome Score, CPR; cardiopulmonary resusitaition, PIM3; The Pediatric Index of Mortality 3.

DOI: https://doi.org/10.2478/jccm-2023-0027 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Journal RSS Feed
Language: English
Page range: 252 - 261
Submitted on: Jun 17, 2023
Accepted on: Sep 19, 2023
Published on: Nov 14, 2023
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
pediatric trauma,
traumatic brain injury,
children,
enteral nutrition,
outcomes
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2023 Merve Misirlioglu, Faruk Ekinci, Dincer Yildizdas, Ozden Ozgur Horoz, Hayri Levent Yilmaz, Faruk Incecik, Mazhar Ozsoy, Ahmet Yontem, Sevcan Bilen, Sena Silay, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 9 (2023): Issue 4 (October 2023)
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