Prognostic Factors of Severe TBI in Children Aged 2鈥�16 Years
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Prognostic Factors of Severe Traumatic Brain Injury Outcome in Children Aged 2鈥�16 Years at A Major Neurosurgical Referral Centre
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Choon Hong Kan, Mohd Saffari, Teik Hooi Khoo
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Prognostic Factors of Severe Traumatic Brain Injury Outcome in Children Aged 2鈥�16 Years at A Major Neurosurgical Referral Centre
Year: 2009
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Traumatic Brain Injury (TBI) is a leading cause of death and disability among children, yet the literature surrounding pediatric TBI remains limited. This study aims to investigate prognostic factors associated with severe TBI in children, specifically those with a Glasgow Coma Score of less than 8. The research involved a thorough analysis of clinical presentations, laboratory parameters, and computed tomography (CT) features in 146 children treated at Kuala Lumpur Hospital between 2001 and 2006. The outcomes of these patients were assessed at six months using the Pediatric Cerebral Performance Categories Scale, categorized as either good or poor outcomes, while various factors influencing these outcomes were analyzed using logistic regression models.
Prognostic Factors of Poor Outcome
One key finding from the study is that a low coma score upon admission is independently associated with poor outcomes in pediatric severe TBI. The multivariate logistic regression model revealed several significant predictors: the presence of diabetes insipidus (OR: 7.16), a prolonged PT ratio (OR: 23.17), elevated serum glucose levels (OR: 1.19), and total white blood cell counts (OR: 1.08) upon admission. Particularly notable is the finding that the odds of a poor outcome rise dramatically with the presence of diabetes insipidus within the first three days following TBI, indicating that this factor should be closely monitored as part of the initial assessment of pediatric TBI patients.
Conclusion
The knowledge of critical prognostic factors associated with severe TBI in children has significant implications for managing and improving outcomes in this vulnerable population. By identifying such factors early in the course of treatment, healthcare professionals, particularly neurosurgeons and neurocritical care specialists, can better tailor their interventions and monitor patients more effectively. While the outcomes observed in this study provide valuable insights, further research is needed to explore these factors' complexities and their implications on both immediate management and long-term recovery in pediatric TBI cases.
FAQ section (important questions/answers):
What is the focus of this study on TBI in children?
The study evaluates prognostic factors in children with severe traumatic brain injury, aiming to identify early indicators that can help predict outcomes and improve management strategies.
What factors were found to predict poor outcomes in TBI?
Low coma score on admission, presence of diabetes insipidus, hyperglycemia, prolonged PT ratio, and leukocytosis were identified as significant predictors of poor outcomes in children with severe TBI.
How were outcomes assessed after the children experienced TBI?
Outcomes were assessed six months post-injury using the Pediatric Cerebral Performance Categories Scale, categorizing patients into good or poor outcome groups based on their recovery.
What were the key findings regarding age and gender in TBI outcomes?
The study found no significant association between age groups or gender and outcomes in severe TBI among the children, suggesting other factors may be more critical in prognosis.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for 鈥淧rognostic Factors of Severe TBI in Children Aged 2鈥�16 Years鈥�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Pur (P奴r):
The term 'poor' in this context refers to unfavorable outcomes following severe traumatic brain injury (TBI) in children. Identifying factors that lead to poor outcomes is essential for improving clinical management and developing better prognostic tools to predict recovery potential and enhance treatment strategies in pediatric neurotrauma.
2) Coma:
The term 'coma' refers to a state of unresponsiveness in patients with severe TBI, assessed using the Glasgow Coma Score (GCS) or Children's Coma Score. The severity and depth of coma at admission are critical prognostic indicators, as lower coma scores correlate with worse outcomes and increased mortality rates in children.
3) Study (Studying):
The 'study' refers to the longitudinal examination of children with severe TBI to identify prognostic factors influencing outcomes. Research in this area is vital due to the limited existing literature on pediatric neurotrauma, offering insights that can refine treatment protocols and improve survival and rehabilitation rates in affected children.
4) Performance:
'Performance' relates to the Pediatric Cerebral Performance Categories Scale used to evaluate functional outcomes in children post-TBI. This scale helps categorize recovery levels and assess the efficacy of interventions over time, making it an essential tool for clinicians to monitor progress, guide rehabilitation, and inform families about prognosis.
5) Swelling:
Swelling in the context of TBI refers to brain edema, which can exacerbate injury and affect outcomes. The presence of brain swelling, as identified through imaging studies, is associated with deteriorating neurological functions. Understanding its impact aids in decision-making regarding surgical interventions and medical management of intracranial pressure.
6) Table:
The term 'table' refers to statistical tables that present findings or criteria, such as age-adjusted systolic blood pressure cutoffs used to define hypotension in children. Accurate tables are crucial for clinical assessments and allow healthcare providers to compare patient data against established norms to predict outcomes effectively.
7) Death:
'Death' denotes the most severe outcome of TBI, which is a significant concern in pediatric cases. Tracking mortality rates helps assess the effectiveness of current treatment protocols and highlights areas needing improvement, ultimately guiding public health initiatives aimed at reducing TBI fatalities among children.
8) Blood:
In the context of this study, 'blood' refers to various laboratory parameters, such as glucose levels and white blood cell counts, which were assessed on admission. These metrics can indicate physiological stress and are crucial in determining prognosis, thus influencing treatment protocols for pediatric TBI patients.
9) Reliability:
'Reliability' pertains to the consistency of medical scoring systems like the Glasgow Coma Score when applied to children. Establishing the reliability of these tools is vital for ensuring accurate diagnosis and prognostication, thereby improving the management of severe TBI and minimizing inter-observer discrepancies in clinical settings.
10) Knowledge:
'Knowledge' encompasses the understanding gained from research on prognostic factors affecting TBI outcomes. Increased knowledge enables healthcare professionals to refine treatment strategies, facilitate informed decisions, and ultimately enhance recovery rates and quality of life for children suffering from severe traumatic brain injuries.
11) Science (Scientific):
'Science' in this context refers to the systematic study and application of evidence-based medicine to understand and manage pediatric TBI. Scientific research underpins clinical guidelines and protocols, driving advancements that improve patient outcomes and expand the understanding of brain injury mechanisms and recovery processes in children.
12) Indian:
'Indian' relates to the population referenced in the study results that challenge previously established Western norms regarding pediatric TBI outcomes. This indicates the significance of context-specific research, as cultural and regional differences can impact injury patterns, recovery factors, and overall treatment efficacy in children with TBI.
13) Doubt:
'Doubt' refers to uncertainties regarding the predictive value of certain prognostic factors in pediatric TBI, such as the reliability of initial coma scores. Discussing doubt in the literature indicates the need for ongoing research to clarify these factors and to optimize clinical approaches based on robust, evidence-based outcomes.
14) Male (M膩l膿):
'Male' denotes the majority demographic observed in the study, highlighting gender differences in pediatric TBI. Understanding the impact of gender on injury outcomes informs treatment strategies and emphasizes the need for gender-tailored research in neurotrauma, potentially uncovering unique vulnerabilities or resilience factors in boys and girls.
15) Road:
'Road' signifies the common mechanism of injury in pediatric TBI cases, particularly road traffic accidents (RTAs). Addressing this type of injury emphasizes the need for public safety measures and preventative strategies, which are crucial in reducing the incidence of severe TBI resulting from such accidents.
16) Post:
'Post' relates to events occurring after the initial injury, such as the development of complications like diabetes insipidus or monitoring parameters following TBI. Understanding post-injury developments is essential for managing long-term outcomes and tailoring rehabilitation efforts to address ongoing challenges faced by pediatric patients.
Other Science Concepts:
Discover the significance of concepts within the article: 鈥�Prognostic Factors of Severe TBI in Children Aged 2鈥�16 Years鈥�. Further sources in the context of Science might help you critically compare this page with similair documents:
Child, Gender, Gender difference, Age-group, Ethics committee, CT scan, Clinical presentation, Systolic blood pressure, Total White Blood Cell count, Serum glucose level, Platelet count, Hyperglycaemia, Cross-sectional analysis, Traumatic brain injury, Prognostic Factor, Road traffic accident, Cerebral perfusion pressure, Intracranial pressure (ICP), Diabetes insipidus, Statistical Package for Social Sciences (SPSS), Intracranial Pressure, Glasgow coma score, Multivariate Logistic Regression, Paediatric patients, Univariate analysis, Surgical evacuation, Poor outcome, Modified Glasgow coma scale, Secondary brain injury, Good outcome.