Does Hypertension at Initial Presentation Affect Outcomes in Pediatric Traumatic Brain Injury?
Ashley D. Freeman, MD1; Matthew Santore, MD1; Katherine Baxter, MD2; Caitlin Fitzgerald, MD2; Lucas Neff, MD1; Courtney McCracken, PhD3; Leah Bryan, MPH3; Jill Morsberger, MD; Arslan Zahid, MD
1Emory University and Children's Healthcare of Atlanta, Atlanta, GA; 2Emory University, Atlanta, GA; 3Emory University School of Medicine, Department of Pediatrics, Atlanta, GA; 4Emory University School of Medicine, Atlanta, GA
Background: The adult literature suggests that patients with traumatic brain injury (TBI) who are hypertensive on presentation have worsened outcomes and mortality compared to those who are normotensive. The purpose of this study is to determine if there is an association between age-adjusted hypertension on presentation and outcomes in pediatric TBI.
Methods: 153 TBI patients with Glasgow Coma Scale (GCS) of 8 or less, on presentation to our facility, from January 2010 to December 2015 were analyzed. Patients were excluded if their presenting blood pressure was less than the 5th percentile for age or if they received cardiopulmonary resuscitation prior to admission. Hypertension was defined as greater than the 90th percentile for age. Data points analyzed included: first blood pressure recorded in the patient chart, initial GCS, length of stay, need for neurosurgical intervention, duration of mechanical ventilation, need for inpatient rehabilitation, and mortality.
Results: 70% (107/153) of patients were hypertensive and 30% (46/153) were normotensive on presentation. Both groups had a median GCS of 3. In comparing the hypertensive and normotensive groups, no statistically significant differences were noted in mortality (13.21% vs 13.04%) , duration of mechanical ventilation (2 vs 3 days), length of stay (6 vs 8 days), need for neurosurgical intervention (50.47% vs 50%), or requirement of inpatient rehabilitation (47.66% vs 48.89%).
Conclusions: Contrary to the adult literature, pediatric patients with TBI who are hypertensive on presentation do not seem to have worsened mortality or outcomes compared to those who are normotensive, highlighting the differences in physiology.
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