Ajit Sarnaik1, Nikki Miller Ferguson2, A M Iqbal O'Meara2, Shruti Agrawal3, Akash Deep4, Sandra Buttram5, Michael J Bell6, Stephen R Wisniewski7, James F Luther7, Adam L Hartman8, Monica S Vavilala9. 1. Departments of Pediatrics, Wayne State University, Detroit, MI, USA. 2. Departments of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA. 3. Departments of Pediatrics, Addenbrookes Hospital, Cambridge, UK. 4. Departments of Pediatrics, Kings College Hospital, London, UK. 5. Departments of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA. 6. Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh, 3434 Fifth Avenue, Pittsburgh, PA, 15260, USA. bellmj4@upmc.edu. 7. Departments of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA. 8. The Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA. 9. Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. METHODS: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score ≤ 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5-< 11, 11-18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan-Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. RESULTS: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. CONCLUSIONS: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury-unrelated to AHT-that may lead to testable hypotheses in the future.
BACKGROUND: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. METHODS: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score ≤ 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5-< 11, 11-18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan-Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. RESULTS: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. CONCLUSIONS: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury-unrelated to AHT-that may lead to testable hypotheses in the future.
Authors: Patrick M Kochanek; Nancy Carney; P David Adelson; Stephen Ashwal; Michael J Bell; Susan Bratton; Susan Carson; Randall M Chesnut; Jamshid Ghajar; Brahm Goldstein; Gerald A Grant; Niranjan Kissoon; Kimberly Peterson; Nathan R Selden; Robert C Tasker; Karen A Tong; Monica S Vavilala; Mark S Wainwright; Craig R Warden Journal: Pediatr Crit Care Med Date: 2012-01 Impact factor: 3.624
Authors: P David Adelson; John Ragheb; Paul Kanev; Douglas Brockmeyer; Sue R Beers; S Danielle Brown; Laura D Cassidy; Yuefang Chang; Harvey Levin Journal: Neurosurgery Date: 2005-04 Impact factor: 4.654
Authors: Rachel M Stanley; Bema K Bonsu; Weiyan Zhao; Peter F Ehrlich; Alexander J Rogers; Huiyun Xiang Journal: Pediatrics Date: 2011-12-19 Impact factor: 7.124
Authors: L Ewing-Cobbs; L Kramer; M Prasad; D N Canales; P T Louis; J M Fletcher; H Vollero; S H Landry; K Cheung Journal: Pediatrics Date: 1998-08 Impact factor: 7.124
Authors: H S Levin; E F Aldrich; C Saydjari; H M Eisenberg; M A Foulkes; M Bellefleur; T G Luerssen; J A Jane; A Marmarou; L F Marshall Journal: Neurosurgery Date: 1992-09 Impact factor: 4.654
Authors: Wynne E Morrison; José J Arbelaez; James C Fackler; Antonio De Maio; Charles N Paidas Journal: Pediatr Crit Care Med Date: 2004-03 Impact factor: 3.624
Authors: A P Regensburger; V Konrad; R Trollmann; I Y Eyüpoglu; H Huebner; J Zierk; T M K Völkl; F B Fahlbusch Journal: Childs Nerv Syst Date: 2019-03-02 Impact factor: 1.475
Authors: R Constance Wiener; Christopher Waters; Matthew Harper; Alcinda K Trickett Shockey; Ruchi Bhandari Journal: J Emerg Med Date: 2022-05-11 Impact factor: 1.473
Authors: Michael J Bell; Bedda L Rosario; Patrick M Kochanek; P David Adelson; Kevin P Morris; Alicia K Au; Michelle Schober; Warwick Butt; Richard J Edwards; Jerry Zimmerman; Jose Pineda; Truc M Le; Nathan Dean; Michael J Whalen; Anthony Figaji; James Luther; Sue R Beers; Deepak K Gupta; Jessica Carpenter; Sandra Buttram; Stephen R Wisniewski Journal: JAMA Netw Open Date: 2022-07-01
Authors: Shiyao Gao; Anthony Fabio; Bedda L Rosario; M Kathleen Kelly; Sue R Beers; Michael J Bell; Stephen R Wisniewski Journal: Dev Neurorehabil Date: 2021-04-19 Impact factor: 1.907
Authors: Elizabeth A Newell; Brittany P Todd; Zili Luo; Lucy P Evans; Polly J Ferguson; Alexander G Bassuk Journal: J Neurotrauma Date: 2019-12-05 Impact factor: 4.869