Intracranial Hypertension and Cerebral Hypoperfusion in Children With Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults.
Intracranial Hypertension and Cerebral Hypoperfusion in Children With Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults.
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DOI：
10.1097/pcc.0000000000000709
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Bell MJ
中科院分区：
文献类型：
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作者：
Miller Ferguson N;Shein SL;Kochanek PM;Luther J;Wisniewski SR;Clark RS;Tyler-Kabara EC;Adelson PD;Bell MJ
The evidence to guide therapy in pediatric TBI is lacking, including insight into the ICP/CPP thresholds in abusive head trauma (AHT). We examined ICP/CPP thresholds and indices of ICP and CPP burden in relationship to outcome in severe TBI and in accidental and AHT cohorts. A prospective observational study. PICU in a tertiary children’s hospital. Children <18y admitted to PICU with severe TBI and had ICP monitoring. A pediatric TBI database was interrogated with 85 patients (18 AHT) enrolled. Hourly ICP and CPP (in mm Hg) were collated and compared to various thresholds. C-statistics for ICP and CPP data in the entire population were determined. Intracranial hypertension and cerebral hypoperfusion indices were formulated based on number of hours with ICP>20 and CPP<50, respectively. A secondary analysis was performed on accidental and AHT cohorts. All of these were compared with dichotomized 6 month GOS scores. The models with the number of hours with ICP>20 (C=0.641, 95% confidence interval: 0.523, 0.762) and CPP<45 (C=0.702, 95% confidence interval: 0.586, 0.805) had the best fits to discriminate outcome. Two factors were independently associated with a poor outcome, number of hours ICP>20 and AHT (OR=5.101, 95% CI: 1.571, 16.563). As the number of hours with ICP>20 increase by 1, the odds of a poor outcome increased by 4.6% (OR=1.046, 95% CI: 1.012, 1.082). Thresholds did not differ between accidental vs. AHT. The intracranial hypertension and cerebral hypoperfusion indices were both associated with outcome. The duration of hours of ICP>20 and CPP<45 best discriminated poor outcome. As the number of hours ICP>20 increase by 1, the odds of a poor outcome increased by 4.6%. Although AHT was strongly associated with unfavorable outcome, ICP/CPP thresholds did not differ between accidental and AHT.
