Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma

Kokoska, Evan R.; Smith, Gregory S.; Pittman, Thomas; Weber, Thomas

doi:10.1016/s0022-3468(98)90457-2

Cited by 136 publications

(67 citation statements)

References 26 publications

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“…The adverse relationship between hypotension and poor outcome in children with moderate and severe TBI has been previously reported, but each study used a different definition of hypotension (3)(4)(5)(6). In this study, we have shown that the incidence of hypotension varies according to the definition of hypotension used (SBP < 5 th percentile for age or SBP < 90mmHg).…”

Section: Discussionmentioning

confidence: 53%

See 1 more Smart Citation

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Coates¹,

Vavilala²,

Mack³

et al. 2005

Critical Care Medicine

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Objective-To examine the influence of definition and location (field, emergency department [ED] or Pediatric Intensive Care Unit [PICU]) of hypotension on outcome following severe pediatric Traumatic Brain Injury (TBI). Participants-93 children < 14 years of age with TBI following injury, head abbreviated injury score (AIS) ≥ 3, and PICU admission Glasgow Coma Sale (GCS) score < 9 formed the analytic sample. Data sources included the Harborview Trauma Registry and Hospital Records. Design-Retrospective Cohort study. Setting-HarborviewOutcome Measures-The relationship between hypotension and outcome was examined comparing two definitions of hypotension: 1) systolic blood pressure (SBP) < 5 th percentile for age and 2) SBP < 90 mmHg. Hospital discharge Glasgow Outcome score (GOS) < 4, or disposition of either death or discharge to a skilled nursing facility were considered poor outcomes. PICU and hospital length of stay (LOS) were also examined.Results-SBP < 5 th percentile for age was more highly associated with poor hospital discharge GOS (p = 0.001), poor disposition (p = 0.02), PICU LOS (RR 9.5; 95% CI 6.7-12.3) and hospital LOS (RR 18.8;) than SBP < 90mmHg. Hypotension occurring in either the field or ED, but not in the PICU, was associated with poor GOS (p = 0.008), poor disposition (p= 0.03) and hospital LOS (RR 18.7; 95% CI 13.1-24.2).Conclusions-Early hypotension, defined as SBP < 5 th percentile for age in the field and/or ED, was a better predictor of poor outcome than delayed hypotension or the use of SBP < 90 mmHg.

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Section: Discussionmentioning

confidence: 53%

“…In children, hypotension on admission to the hospital is also associated with poor outcome (3)(4)(5)(6). Adjusted for injury severity, children presenting to the ED with hypotension following TBI have a 3 fold higher mortality rate compared to patients with blood pressure appropriate for age (3).…”

Section: Introductionmentioning

confidence: 99%

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Coates¹,

Vavilala²,

Mack³

et al. 2005

Critical Care Medicine

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“…Beyond these limits of autoregulation, CBF depends on MAP/CPP; hypotension results in cerebral ischemia, and hypertension causes cerebral hyperemia. Hypotension after pediatric TBI is associated with poor outcome [10][11][12].…”

Section: Cerebral Autoregulationmentioning

confidence: 99%

“…Trauma accounts for 36% of deaths in U.S. children 1-14 years of age [4], and traumatic brain injury (TBI) is the leading cause of pediatric trauma [5]. Low Glasgow Coma Scale score, coagulopathy, hyperglycemia, early hypotension, and impaired cerebral autoregulation are associated with poor outcome after pediatric TBI [6][7][8][9][10][11][12]. In this review, we discuss what we know about CBF and cerebral autoregulation in children with and without TBI.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

133

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Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury.

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“…64,150 In children, systolic pressure goals are lowered in an age-dependent manner. 83 Intravenous fluids should be administered to avoid hypotension or to minimize the duration and extent of hypotension. The scalp has a rich blood supply and scalp lacerations should be addressed as a treatable cause of hypotension.…”

Section: 120mentioning

confidence: 99%

Prehospital management of traumatic brain injury

Stiver¹,

Manley²

2008

FOC

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The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

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Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma

Cited by 136 publications

References 26 publications

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Prehospital management of traumatic brain injury

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