Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay

Abstract EN

We aim to study the association between hyperglycemia and in-hospital outcomes among children with moderate and severe traumatic brain injury (TBI).

This retrospective cohort study was conducted in a tertiary pediatric hospital between 2003 and 2013.

All patients < 16 years old who presented to the Emergency Department within 24 hours of head injury with a Glasgow Coma Scale (GCS) ≤ 13 were included.

Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days.

Hyperglycemia was defined as glucose > 200 mg/dL (11.1 mmol/L).

Among the 44 patients analyzed, the median age was 8.6 years (interquartile range (IQR) 5.0–11.0).

Median GCS and pediatric trauma scores were 7 (IQR 4–10) and 4 (IQR 3–6), respectively.

Initial hyperglycemia was associated with death (37% in the hyperglycemia group versus 8% in the normoglycemia group, p=0.019), reduced median PICU-free days (6 days versus 11 days, p=0.006), and reduced median ventilation-free days (8 days versus 12 days, p=0.008).

This association was however not significant in the stratified analysis of patients with GCS ≤ 8.

Conclusion.

Our findings demonstrate that early hyperglycemia is associated with increased mortality, prolonged duration of mechanical ventilation, and PICU stay in children with TBI.