Characteristics and outcomes of critically ill children with moderate-to-severe traumatic brain injury

Objective

To characterize outcomes of paediatric moderate-to-severe traumatic brain injury (TBI), defined by a Glasgow Coma Scale (GCS) ≤ 12.

Design

Retrospective, single-centre cohort study (July 2010 and June 2020).

Setting

Medical-surgical tertiary paediatric intensive care unit (PICU) in a level 1 university medical trauma centre.

Patients

One-hundred and thirty subjects < 18 years (moderate N = 56, severe N = 74).

Measurements and main results

Subjects were stratified according to favourable (Paediatric Cerebral Performance Category [PCPC] Scale ≤ 3) and poor (PCPC ≥ 4) neurological outcome determined at PICU discharge. One-hundred and six patients (81.5%) had PCPC ≤ 3; of those, N = 55 (52%) had moderate TBI and N = 51 (48%) severe TBI. Twelve patients (9.2%) died, of whom eight (66.7%) within 24 h of PICU admission. Intracranial pressure (ICP) monitoring was performed in N = 12 (50%) patients with PCPC ≥ 4 and in N = 15 (14.2%) patients with PCPC ≤ 3. No clinically relevant differences in serum sodium, glucose, temperature, or blood pressure management during the first 72 h of PICU admission were observed between patients with and without favourable outcome. Mortality was highest among patients with severe TBI (N = 11, 14.9%). Among survivors with PCPC ≥ 4, N = 11 (91.7%) were discharged to a rehabilitation facility compared to N = 22 (20.8%) with PCPC ≤ 3.

Conclusion

Severe paediatric TBI (pTBI) remains an important cause of serious morbidity and mortality. Patients with moderate pTBI had a favourable outcome at PICU discharge, although the outcome measurement used may not be granular enough to discriminate. Follow-up after discharge is essential to optimize outcome on physical, cognitive, behavioural, and social functioning.