Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

Abstract

Objective: To identify the relationship between admission hyperglycemia and outcome in children with severe brain injury at hospital discharge and 6 months later.Method: A retrospective analysis of blood glucose levels was conducted in 61 children with severe brain injury admitted to the Pediatric Intensive Care Unit between November 1, 2005 and October 30, 2009. Hyperglycemia was considered for a cut off value of > 150 mg/dL, based on literature. Outcome was measured with the Glasgow Outcome Scale at hospital discharge and 6 months after discharge. Death was also analyzed as an outcome measure. Results:Mean admission blood glucose of the patients was 251 mg/dL (68-791). Hyperglycemia was noted on admission in 51 (83.6%) patients. A moderately significant positive correlation was found between admission blood glucose and severity of head trauma according to Abbreviated Injury Score (r = 0.46). Mean admission glucose level of non-survivors was significantly higher (207 mg/dL vs. 455 mg/dL, p < 0.001). Mean blood glucose level of the patients in bad outcome group was found significantly higher compared to that of the patients in good outcome group at hospital discharge and 6 months after discharge (185 mg/dL vs. 262 mg/dL, p < 0.15 and 184 mg/dL vs. 346 mg/dL, p < 0.04, respectively).Conclusions: Hyperglycemia could be considered as a marker of brain injury and, when present upon admission, could reflect extensive brain damage, frequently associated with mortality and bad outcome. Further studies are needed to investigate the effect of strict glycemic control on mortality and outcomes.J Pediatr (Rio J). 2011;87(4):325-328: Severe head injury, hyperglycemia, outcome, children. ResumoObjetivo: Identificar a relação entre hiperglicemia na admissão e desfecho das crianças com traumatismo cerebral grave na alta hospitalar e 6 meses depois.Método: Análise retrospectiva da glicemia de 61 crianças com traumatismo cerebral grave admitidas na unidade de tratamento intensivo pediátrico entre 1/11/2005 e 30/10/2009. Foi considerado um ponto de corte de > 150 mg/dL para o diagnóstico da hiperglicemia, com base na literatura. A evolução foi avaliada pela escala de resultados de Glasgow na alta hospitalar e 6 meses após a alta. O óbito também foi analisado como uma evolução.Resultados: A glicemia média dos pacientes na admissão foi de 251 mg/dL (68-791). Verificou-se hiperglicemia na admissão em 51 pacientes (83,6%). Encontrou-se uma correlação positiva moderadamente significativa entre glicemia na admissão e gravidade do traumatismo craniano segundo a escala abreviada de injúrias (r = 0,46). A glicemia média dos não sobreviventes foi significativamente maior (207 mg/dL versus 455 mg/dL, p < 0,001). A glicemia média dos pacientes com má evolução foi significativamente maior, comparada à daqueles com boa evolução, na alta hospitalar e 6 meses após a alta (185 mg/dL versus 262 mg/dL, p < 0,15 e 184 mg/dL versus 346 mg/dL, p < 0,04, respectivamente). Conclusões:A hiperglicemia pode ser considerada um marcador de lesão cereb...

Early metabolic derangements and unfavorable outcomes in pediatric traumatic brain injury: a retrospective multi-center cohort study

“…This leads to impaired aerobic glycolysis and intracellular acidosis that in turn cause a secondary toxic-ischemic effect on the brain (7). The association between these metabolic alterations and outcomes of pediatric TBI have been investigated in several single-center studies (2,5,8,9). These prior single-center studies have identified admission hyperglycemia as an important predictor of mortality in pediatric TBI (9)(10)(11)(12)(13)(14).…”

“…The association between these metabolic alterations and outcomes of pediatric TBI have been investigated in several single-center studies (2,5,8,9). These prior single-center studies have identified admission hyperglycemia as an important predictor of mortality in pediatric TBI (9)(10)(11)(12)(13)(14). Early hyperglycemia has been traditionally described as the presence of any hyperglycemia in the first 48 h of injury (13,14), while other retrospective cohort studies have proposed a shorter window between 12 to 24 h post injury (5,15).…”

“…Early hyperglycemia has been traditionally described as the presence of any hyperglycemia in the first 48 h of injury (13,14), while other retrospective cohort studies have proposed a shorter window between 12 to 24 h post injury (5,15). The association between early, compared to late or persistent hyperglycemia and pediatric TBI outcomes has not been well-established (9)(10)(11)(12)(13)(14). Additionally, mortality has been the primary outcome of interest in these studies whereas functional outcome has been less adequately described (9)(10)(11)(12)(13)(14).…”

“…The association between early, compared to late or persistent hyperglycemia and pediatric TBI outcomes has not been well-established (9)(10)(11)(12)(13)(14). Additionally, mortality has been the primary outcome of interest in these studies whereas functional outcome has been less adequately described (9)(10)(11)(12)(13)(14). Furthermore, while lactate and acidosis in adult multisystem trauma are associated with massive hemorrhage and prolonged ICU admission (16,17), there is a paucity of literature examining their roles as prognostic markers in pediatric TBI (2,4).…”

Comparison of point-of-care glucometers and laboratory based glucose oxidase test in determining blood glucose levels

“…Alteration in glucose homeostasis is a common metabolic emergency especially in the neonatal unit and the Children's emergency room and is an important determinant of patient outcomes. [1][2][3][4][5][6] In Nigeria, the prevalence of hypoglycaemia among children admitted into a typical paediatric emergency ward could be as high as 6.2% and it is commonly associated with severe malaria, septicaemia, pneumonia, and protein energy malnutrition. 7 To prevent severe complications and improve patient outcomes, it is necessary to reliably determine the blood glucose levels as quickly as possible and institute intervention when needed.…”