TY - JOUR
T1 - Age and Mortality in Pediatric Severe Traumatic Brain Injury
T2 - Results from an International Study
AU - For the Investigators of the ADAPT Trial
AU - Sarnaik, Ajit
AU - Ferguson, Nikki Miller
AU - O’Meara, Am Iqbal
AU - Agrawal, Shruti
AU - Deep, Akash
AU - Buttram, Sandra
AU - Bell, Michael J.
AU - Wisniewski, Stephen R.
AU - Luther, James F.
AU - Hartman, Adam L.
AU - Vavilala, Monica S.
AU - Mahoney, Sarah
AU - Gupta, Deepak
AU - Beca, John
AU - Loftis, Laura
AU - Morris, Kevin
AU - Piper, Lauren
AU - Slater, Anthony
AU - Walson, Karen
AU - Bennett, Tellen
AU - Kilbaugh, Todd
AU - O’Meara, A. M.Iqbal
AU - Dean, Nathan
AU - Chima, Ranjit S.
AU - Biagas, Katherine
AU - Wildschut, Enno
AU - Peters, Mark
AU - LaRovere, Kerri
AU - Balcells, Joan
AU - Robertson, Courtney
AU - Gertz, Shira
AU - Cooper, Sian
AU - Wainwright, Mark
AU - Murphy, Sarah
AU - Kuluz, John
AU - Butt, Warwick
AU - O’Brien, Nicole
AU - Thomas, Neal
AU - Erickson, Simon
AU - Samuel, J. Mahil
AU - Agbeko, Rachel
AU - Edwards, Richard
AU - Ramakrishnan, Kesava Ananth
AU - Winkler, Margaret
AU - Borasino, Santiago
AU - Natale, Joanne
AU - Giza, Christopher
AU - Hilfiker, Mary
AU - Shellington, David
AU - Pineda, Jose
N1 - Publisher Copyright:
© 2018, Springer Science+Business Media, LLC.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. Methods: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score = 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5–< 11, 11–18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan–Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. Results: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. Conclusions: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury—unrelated to AHT—that may lead to testable hypotheses in the future.
AB - Background: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. Methods: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score = 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5–< 11, 11–18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan–Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. Results: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. Conclusions: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury—unrelated to AHT—that may lead to testable hypotheses in the future.
KW - Age
KW - Comparative effectiveness research
KW - Pediatric neurocritical care
KW - Pediatric traumatic brain injury
KW - Secondary injuries
UR - http://www.scopus.com/inward/record.url?scp=85045139920&partnerID=8YFLogxK
U2 - 10.1007/s12028-017-0480-x
DO - 10.1007/s12028-017-0480-x
M3 - Article
C2 - 29476389
AN - SCOPUS:85045139920
SN - 1541-6933
VL - 28
SP - 302
EP - 313
JO - Neurocritical Care
JF - Neurocritical Care
IS - 3
ER -