Outcome analysis and outcome predictors of traumatic head injury in childhood: Analysis of 454 observations

“…After controlling for exogenous administration of mannitol and hypertonic saline, the association between hypernatremia and mortality persisted (18, 19). These studies did not specifically look at the change in sodium over time.…”

Section: Discussionmentioning

confidence: 99%

“…A case series of three patients reported EVD associated severe dehydration (22). In a series of children who suffered traumatic brain injury, severe hyponatremia < 125 meq/dL was associated with increased mortality (18). Williams et al evaluated 2,343 patients who underwent brain tumor resection and found hyponatremia occurred in 8.7% of patients (3).…”

Section: Discussionmentioning

confidence: 99%

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Topjian¹,

Stuart²,

Pabalan³

et al. 2014

Pediatric Critical Care Medicine

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Objective Dysnatremia is common in critically ill children due to disruption of hormonal homeostasis. Children with brain injury are at risk for SIADH, cerebral salt wasting and sodium losses due to externalized ventricular drain (EVD) placement. We hypothesized that among pediatric intensive care unit (PICU) patients managed with an EVD, hyponatremia is common, hyponatremia is associated with seizures and in-hospital mortality, and greater sodium fluctuations are associated with in-hospital mortality. Design Retrospective observational study Setting Tertiary care PICU Patients All pediatric patients treated in the PICU with an EVD from January 2005 to December 2009. Patients were identified by searching the physician order entry database for EVD orders. Hyponatremia was defined as the minimum sodium during patients’ EVD time and was categorized as mild (131-134 meq/L) or moderate-severe (≤130 meq/L). Magnitude of sodium fluctuation was defined as the difference between a patient’s highest and lowest sodium during the time in which an EVD was in use (up to 14 days). Seizure was defined as a clinically evident convulsion during EVD presence. A priori confounders were age, history of epilepsy, and EVD indication. Multivariable regression was performed to test the association between sodium derangements and outcomes. Interventions None. Measurements and Main Results Three hundred eighty patients were eligible. One hundred nine (29%) had mild hyponatremia, and 30 (8%) moderate-severe hyponatremia. Twenty eight (7%) patients had a seizure while hospitalized. Eighteen patients died (5%) prior to discharge. Survivors had a median daily sodium fluctuation of 1 [0, 5] vs non-survivors 9 [6, 11], (p< 0.001) and a median sodium fluctuation of 5 meq/L [interquartile range 2, 8] vs non-survivors 15 meq/L [9, 24] (p<0.001) during EVD management. After controlling for a priori covariates and potential confounders, hyponatremia was not associated with an increased odds of seizures or in-hospital mortality. However, greater fluctuations in daily sodium (OR 1.38, 95% CI (1.06, 1.8)) and greater fluctuations in sodium during EVD management were associated with increased odds of in-hospital mortality (OR 1.59, 95% CI (1.2, 2.11)). Conclusion Hyponatremia was common in PICU patients treated with EVDs but not associated with seizures or in-hospital mortality. Greater sodium fluctuations during EVD management were independently associated with increased odds of in-hospital mortality.

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“…An example of the pediatric risk prediction scores, the Pediatric Risk of Mortality (PRISM III) [5], is a widely used scoring mechanism in pediatric ICU (PICU) [9] that has been validated in various settings as both an individual predictor and a significant predictor in a multivariate model in the United States and internationally [13][14][15][16][17][18][19][20][21]. A state-of-the-art scheme, PRISM III has an additive stepwise structure that relies on 17 physiological variables and 26 ranges.…”

Section: Pediatric Population Risk Scoresmentioning

confidence: 99%

Designing optimal mortality risk prediction scores that preserve clinical knowledge

Arzeno

Lawson

Duzinski

et al. 2015

Journal of Biomedical Informatics

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Many in-hospital mortality risk prediction scores dichotomize predictive variables to simplify the score calculation. However, hard thresholding in these additive stepwise scores of the form "add x points if variable v is above/below threshold t" may lead to critical failures. In this paper, we seek to develop risk prediction scores that preserve clinical knowledge embedded in features and structure of the existing additive stepwise scores while addressing limitations caused by variable dichotomization. To this end, we propose a novel score structure that relies on a transformation of predictive variables by means of nonlinear logistic functions facilitating smooth differentiation between critical and normal values of the variables. We develop an optimization framework for inferring parameters of the logistic functions for a given patient population via cyclic block coordinate descent. The parameters may readily be updated as the patient population and standards of care evolve. We tested the proposed methodology on two populations: (1) brain trauma patients admitted to the intensive care unit of the Dell Children's Medical Center of Central Texas between 2007 and 2012, and (2) adult ICU patient data from the MIMIC II database. The results are compared with those obtained by the widely used PRISM III and SOFA scores. The prediction power of a score is evaluated using area under ROC curve, Youden's index, and precision-recall balance in a cross-validation study. The results demonstrate that the new framework enables significant performance improvements over PRISM III and SOFA in terms of all three criteria.

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Outcome analysis and outcome predictors of traumatic head injury in childhood: Analysis of 454 observations

Cited by 23 publications

References 51 publications

Traumatic extradural hematoma in Enugu, Nigeria

Traumatic extradural hematoma in Enugu, Nigeria

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Designing optimal mortality risk prediction scores that preserve clinical knowledge

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