Evaluation of monitoring critical ill children with traumatic brain injury

Variable	Value
Cause of trauma
Out-of-vehicle traffic accidents	42.9 % (n=12)
Falls from a height	21.4 % (n=6)
Blunt trauma	17.9 % (n=5)
In-vehicle traffic accidents	14.3 % (n=4)
Other reasons	3.6 % (n=1)
The type of traumatic brain injury
Extraparenchymal injuries	53.6 % (n=15)
Intraparenchymal injuries	35.7% (n=10)
Bone fractures	10.7% (n=3)
The treatments
Neurosurgery	25% (n=7)
Antibiotic therapy	96.4% (n=27)
Antiepileptic drugs	92.9% (n=26)
Anti-edema treatment	96.4% (n=27)
Thiopental infusion	3.6% (n=1)
Decompressive craniotomy procedure	3.6% (n=1)
Normothermia	100% (n=28)

Table 2.

Evaluation of the monitoring findings of the patients in the pediatric intensive care unit by days

	PICU admission Mean ± SD Min - Max	Hospitalization Day1 Mean ± SD Min - Max	Hospitalization Day2 Mean ± SD Min - Max
Mean Arterial Pressure (mmHg)	82.3 ± 16.8	79.6 ± 13.2	79.5 ± 10.7
58–120	62–109	63–108
Glasgow Coma Scores	8.8 ± 2.3	9.8 ± 2.3	11.0 ± 2.5
5–13	6–14	5–14
Optic Nerve Sheath Diameters (mm) n=24)	5.8 ± 0.4	5.8 ± 0.5	5.7 ± 0.5
4.7–6.7	4.6–6.7	4.6–7.0
NIRS (%)	74.3 ± 11.9	74.2 ± 9.9	70.4 ± 8.2
50–91	55–95	55–89
Noninvasive ICP (mmHg)	16.1 ±1.9	15.9 ± 2.1	15.0 ± 2.5
11.5–20.6	11–21	11–21
Cerebral Perfusion Pressure (mmHg)	67.8 ± 16.7	64.3 ± 11.9	63.8 ± 7.8
40–102	46–88	50–80

[i] NIRS: Near Infrared Spectroscopy, ICP: Intracranial pressure, PICU: Pediatric Intensive Care Unit, mmHg: Millimeter of Hg, Hg: Chemical symbol of mercury, mm: millimeter.

The change of traumatic brain injury classification according to the Glasgow coma score of the patients by days (%)

Evaluation of patients to Glasgow Outcome Scores-E

Table 3.

Evaluations of the prognosis according to the follow-up variables according to the days of hospitalization in the pediatric intensive care unit

Time	Variable	Prognosis	Mean ± SD	p value
PICU admission	NIRS	Good(GOSE 7-8) (n=18)	73.6±10.8	0.71
	Poor (GOSE 1-6)(n=10)	75.4±14.1
	ONSD	Good (GOSE 7-8)(n=16)	5.7±0.4	0.19
	Poor (GOSE 1-6)(n=8)	5.9±0.5
	nICP	Good (GOSE 7-8) (n=16)	15.7±1.8	0.23
	Poor (GOSE 1-6) (n=8)	16.7±2.3
CPP	Good (GOSE 7-8) (n=16)	64.6±14.1	0.20
Poor (GOSE 1-6) (n=8)	74.0±20.6
Hospitalization Day1	NIRS	Good (GOSE 7-8)	72.7±10.3	0.28
	Poor (GOSE 1-6)	76.9±9.0
	ONSD	Good (GOSE 7-8)	5.7±0.5	0.01^*
	Poor (GOSE 1-6)	6.1±0.4
	nICP	Good (GOSE 7-8)	15.1±1.8	0.004^*
	Poor (GOSE 1-6)	17.6±1.1
CPP	Good (GOSE 7-8)	64.7±11.6	0.81
Poor (GOSE 1-6)	63.4±13.5
Hospitalization Day2	NIRS	Good (GOSE 7-8)	69.1±8.0	0.29
	Poor (GOSE 1-6)	72.6±8.5
	ONSD	Good (GOSE 7-8)	5.5±0.4	0.002^*
	Poor (GOSE 1-6)	6.1±0.5
	nICP	Good (GOSE 7-8)	13.9±1.8	0.001^*
	Poor (GOSE 1-6)	17.2±2.3
CPP	Good (GOSE 7-8)	62.9±5.7	0.43
Poor (GOSE 1-6)	65.6±11.1

* t-test; NIRS: Near Infrared Spectroscopy, ONSD: Optic Nerve Sheath Diameter, nICP: Noninvasive Intracranial Pressure, CPP: Cerebral Perfusion Pressure, GOSE: Glasgow Outcome Scale-Extended, PICU: Pediatric Intensive Care Unit.

Table 4.

Comparison of prognosis according to neuromonitorization parameters between days

	p value^*	GOSE 7-8 (Good prognosis)	GOSE 1-6 (Poor Prognosis)	p value ^*
Admission NIRS		75.4±10.0	76.6±11.2	0.572
Day 1 NIRS	0.473	73.7±10.4	78.0±7.4
Admission NIRS		75.4±10.0	76.6±11.2	0.360
Day 2 NIRS	0.009	69.7±8.2	74.1±8.3
Day 1 NIRS		73.7±10.4	78.0±7.4	0.006
Day 2 NIRS	0.003	69.7±8.2	74.1±8.3
Admission ONSD		5.7±0.4	6.0±0.4	0.203
Day 1 ONSD	0.534	5.7±0.5	6.1±0.4
Admission ONSD		5.7±0.4	6.0±0.4	0.449
Day 2 ONSD	0.004	5.5±0.4	6.1±0.5
Day 1 ONSD		5.7±0.5	6.1±0.4	1.000
Day 2 ONSD	0.140	5.5±0.4	6.1±0.5
Admission nICP		15.7±1.8	16.7±2.3	0.243
Day 1 nICP	0.097	15.1±1.8	17.6±1.7
Admission nICP		15.7±1.8	16.7±2.3	0.729
Day 2 nICP	<0.001	14.0±1.8	17.2±2.3
Day 1 nICP		15.1±1.8	17.6±1.7	0.535
Day 2 nICP	0.002	14.0±1.8	17.2±2.3
Admission CPP		64.6±14.1	74.0±20.6	0.240
Day 1 CPP	0.987	64.7±11.6	63.4±13.5
Admission CPP		64.6±14.1	74.0±20.6	0.128
Day 2 CPP	0.604	62.9±5.7	65.6±11.1
Day 1 CPP		64.7±11.6	63.4±13.5	0.687
Day 2 CPP	0.481	62.9±5.7	65.6±11.1

* p: paired samples t test; NIRS: Near Infrared Spectroscopy, ONSD: Optic Nerve Sheath Diameter, nICP: Noninvasive Intracranial Pressure, CPP: Cerebral Perfusion Pressure, GOSE: Glasgow Outcome Scale-Extended.

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DOI: https://doi.org/10.2478/jccm-2025-0001 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 78 - 86

Submitted on: Nov 1, 2024

Accepted on: Nov 24, 2024

Published on: Jan 31, 2025

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:

child,

intensive care,

monitoring,

traumatic brain injury

Related subjects:

Medicine,

Clinical medicine,

Internal medicine,

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2025 Merve Misirlioglu, Dincer Yildizdas, Faruk Ekinci, Ozden Ozgur Horoz, Gulen Gul Mert, 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 11 (2025): Issue 1 (January 2025)

Evaluation of monitoring critical ill children with traumatic brain injury

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