A Pilot Prospective Observational Study of Cerebral Autoregulation and 12-Month Outcomes in Children With Complex Mild Traumatic Brain Injury: The Argument for Sufficiency Conditions Affecting TBI Outcomes.
A Pilot Prospective Observational Study of Cerebral Autoregulation and 12-Month Outcomes in Children With Complex Mild Traumatic Brain Injury: The Argument for Sufficiency Conditions Affecting TBI Outcomes.
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DOI：
10.1097/ana.0000000000000775
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发表时间：
2022-10-01
影响因子：
3.7
通讯作者：
Lele AV
中科院分区：
文献类型：
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作者：
Thamjamrassri T;Watanitanon A;Moore A;Chesnut RM;Vavilala MS;Lele AV
脑自动调节与小儿复杂轻度创伤性脑损伤（TBI）预后之间的关系尚不清楚，本研究对其进行了探讨。我们对0-18岁的复杂轻度TBI住院患者（入院格拉斯哥昏迷量表评分13-15，头部计算机断层扫描异常或有意识丧失史）进行了前瞻性观察研究。采用经颅多普勒超声检查脑自动调节功能，自动调节功能受损定义为自动调节指数< 0.4。我们收集了出院后3、6和12个月的格拉斯哥结局量表扩展儿科评分和健康相关生活质量数据。24例年龄为1.8 - 16.6岁（58.3%为男性）、具有完整12个月结局数据的患者纳入分析。入院时格拉斯哥昏迷量表评分中位数为15分（范围13-15），损伤严重程度评分中位数为12分（范围4-29），23例患者（96%）有孤立性TBI。总体而言，10例（41.7%）患者的脑自动调节功能受损。在3个月时观察到21例儿童中有6例（28.6%）完全恢复，在6个月时观察到16例儿童中有4例（25%）完全恢复，在12个月时观察到24例儿童中有8例（33.3%）完全恢复。在12个月时，自动调节功能完好和受损的患者之间的中位[四分位距]格拉斯哥结局量表扩展儿科评分（2 [2.3] vs. 2 [IQR 1.3]）或健康相关生活质量评分（91.5 [21.1] vs. 90.8 [21.6]）无差异。2/24例（8.3%）患者发生经腹调整的低血压。三分之二患有复杂轻度TBI的儿童在一年内经历了不完全的功能恢复。低血压和脑自动调节的共同发生可能是影响TBI结果所需的充分条件。
The relationship between cerebral autoregulation and outcomes in pediatric complex mild traumatic brain injury (TBI) is unknown, and explored in this study. We conducted a prospective observational study of patients aged 0–18 years hospitalized with complex mild TBI (admission Glasgow Coma Scale score 13–15 with either abnormal computerized tomogram of the head or history of loss of consciousness). Cerebral autoregulation was tested using transcranial Doppler ultrasonography, and impaired autoregulation defined as autoregulation index < 0.4. We collected Glasgow outcome scale extended-pediatrics score and health-related quality of life data at 3, 6, and 12 months after discharge. 24 patients aged 1.8 to 16.6 years (58.3% male) with complete 12-month outcome data were included in the analysis. Median admission Glasgow Coma Scale score was 15 (range 13–15), median injury severity score was 12 (range 4–29) and 23 patients (96%) had isolated TBI. Overall, 10 (41.7%) patients had impaired cerebral autoregulation. Complete recovery was observed in 6 of 21 (28.6%) children at 3 months, in 4 of 16 (25%) children at 6 months, and in 8 of 24 (33.3%) children at 12 months. There was no difference in median [interquartile range] Glasgow outcome scale extended-pediatrics score (2 [2.3] vs. 2 [IQR 1.3]) or health-related quality of life scores (91.5 [21.1] vs. 90.8 [21.6]) at 12 months between those with intact and impaired autoregulation, respectively. Age-adjusted hypotension occurred in 2/24 (8.3%) patients. Two-thirds of children with complex mild TBI experienced incomplete functional recovery at one year. The co-occurrence of hypotension and cerebral autoregulation may be a sufficiency condition needed to affect TBI outcomes.