Abhijit V Lele1, Bhunyawee Alunpipatthanachai2, Crystalyn Clark-Bell2, Arraya Watanitanon2, M Min Xu3, R V T Anne Moore4, Jerry J Zimmerman5, Michael A Portman6, Randall M Chesnut7, Monica S Vavilala2. 1. Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, United States. Electronic address: abhijit2@uw.edu. 2. Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, United States. 3. Department of Laboratories, Seattle Children's Hospital, Department of Laboratory Medicine, University of Washington, Seattle, WA, United States. 4. Department of Neurological Surgery, Harborview Medical Center, Seattle, WA, United States. 5. Professor of Pediatrics and Anesthesiology, Seattle Children's Hospital, Harborview Medical Center, University of Washington, Seattle, WA, United States. 6. Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, United States. 7. Department of Neurological Surgery and Orthopedics, Harborview Medical Center, Seattle, WA, United States.
Abstract
OBJECTIVE: The clinical epidemiology of organ outcomes in pediatric traumatic brain injury (TBI) has not been examined. We describe associated markers of cerebral, cardiac and renal injury after pediatric TBI. DESIGN: Prospective observational study. PATIENTS: Children 0-18 years who were hospitalized with TBI. MEASUREMENTS: Measures of myocardial (at least one elevated plasma troponin [cTnI] ≥ 0.4 ng/ml) and multiorgan (hemodynamic variables, cerebral perfusion, and renal) function were examined within the first ten days of hospital admission and within 24 h of each other. MAIN RESULTS: Data from 28 children who were 11[IQR 10.3] years, male (64.3%), with isolated TBI (67.9%), injury severity score (ISS) 25[10], and admission Glasgow coma score (GCS) 11[9] were examined. Overall, 50% (14 children) had elevated cTnI, including those with isolated TBI (57.9%; 11/19), polytrauma (33.3%; 3/9), mild TBI (57.1% 8/14), and severe TBI (42.9%; 6/11). Elevated cTnI occurred within the first six days of admission and across all age groups, in both sexes, and regardless of TBI lesion type, GCS, and ISS. Age-adjusted admission tachycardia was associated with cTnI elevation (AUC 0.82; p < 0.001). Reduced urine output occurred more commonly in patients with isolated TBI (27.3% elevated cTnI vs. 0% normal cTnI). CONCLUSIONS: Myocardial injury commonly occurs during the first six days after pediatric TBI irrespective of injury severity, age, sex, TBI lesion type, or polytrauma. Age-adjusted tachycardia may be a clinical indicator of myocardial injury, and elevated troponin may be associated with cardio-cerebro-renal dysfunction.
OBJECTIVE: The clinical epidemiology of organ outcomes in pediatric traumatic brain injury (TBI) has not been examined. We describe associated markers of cerebral, cardiac and renal injury after pediatric TBI. DESIGN: Prospective observational study. PATIENTS: Children 0-18 years who were hospitalized with TBI. MEASUREMENTS: Measures of myocardial (at least one elevated plasma troponin [cTnI] ≥ 0.4 ng/ml) and multiorgan (hemodynamic variables, cerebral perfusion, and renal) function were examined within the first ten days of hospital admission and within 24 h of each other. MAIN RESULTS: Data from 28 children who were 11[IQR 10.3] years, male (64.3%), with isolated TBI (67.9%), injury severity score (ISS) 25[10], and admission Glasgow coma score (GCS) 11[9] were examined. Overall, 50% (14 children) had elevated cTnI, including those with isolated TBI (57.9%; 11/19), polytrauma (33.3%; 3/9), mild TBI (57.1% 8/14), and severe TBI (42.9%; 6/11). Elevated cTnI occurred within the first six days of admission and across all age groups, in both sexes, and regardless of TBI lesion type, GCS, and ISS. Age-adjusted admission tachycardia was associated with cTnI elevation (AUC 0.82; p < 0.001). Reduced urine output occurred more commonly in patients with isolated TBI (27.3% elevated cTnI vs. 0% normal cTnI). CONCLUSIONS:Myocardial injury commonly occurs during the first six days after pediatric TBI irrespective of injury severity, age, sex, TBI lesion type, or polytrauma. Age-adjusted tachycardia may be a clinical indicator of myocardial injury, and elevated troponin may be associated with cardio-cerebro-renal dysfunction.
Authors: Divine C Nwafor; Allison L Brichacek; Chase H Foster; Brandon P Lucke-Wold; Ahsan Ali; Mark A Colantonio; Candice M Brown; Rabia Qaiser Journal: J Cent Nerv Syst Dis Date: 2022-05-22