Impact of secondary insults on the outcome of paediatric traumatic brain injury : a retrospective cross sectional study at the Red Cross Children’s Hospital, Cape Town

Abstract

Secondary insults in severe traumatic brain injury (TBI) may worsen outcome; however, these are poorly characterized in children. For example, despite the known association between intracranial pressure (ICP) and poor outcome, there are few large paediatric series on the subject, definitions vary, functional outcome is often not assessed, and the best measures to assess ICP for statistical analysis are unknown. We aimed to document the frequency of secondary insults, and the association of various ICP measures, with outcome in a large cohort of paediatric patients with severe TBI. A retrospective analysis of 5-year prospectively collected data was examined for the frequency of hypoxia, hypotension, raised ICP, and low cerebral perfusion pressure (CPP). ICP parameters included initial ICP, mean ICP in the first 24 hours, mean ICP overall, peak ICP, mean ICP over 20 mmHg, and episodes of ICP over 20 mmHg. Hypotension was defined by age †and height †adjusted mean arterial pressure ranges, and hypoxia was defined as arterial partial pressure of oxygen (PaO2) less than 8kPa or pulse oximetry less than 90%. We examined for univariate and multivariate associations with mortality and the Extended Paediatric Glasgow Outcome Score.