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Clinical Risk Factors for Hyponatremia after Traumatic Brain Injuries in Pediatric Patients
Sophia Abdulhai, MD; Michael Forbes, MD, FCCM; Mary Kay Walsh, BSN, RN; Cecilia Lauer; Mark McCollum, MD, FCCM
Akron Children's Hospital, Akron, OH

INTRODUCTION
Hyponatremia with neurological sequelae is a significant risk for pediatric patients with traumatic brain injuries (TBI), though which patients are at a higher risk of developing hyponatremia is unknown. This study attempts to identify risk factors for hyponatremia in pediatric TBI patients.

METHODS
All pediatric patients with a TBI were identified from June 2012-June 2016. Mechanism of injury, TBI type, and sodium levels were obtained. Epidural hematoma (EDH), subdural hematoma (SDH), subarachnoid hemorrhage (SAH), concussion, basilar skull fracture, non-accidental trauma (NAT), diffuse axonal injury (DAI), cerebral edema, age, and mechanism of injury were chosen as potential risk factors for hyponatremia. Data were analyzed using descriptive statistics, univariate and multivariate analysis.

RESULTS
A total of 1149 patients were included in the study, of which 122 patients had at least one sodium < 135, giving an incidence of hyponatremia of 10.6%. Twenty-six patients had a sodium < 135 at their initial check. TBI type and mechanisms with the highest incidence of hyponatremia were SDH (29/160, 18.1%), EDH (11/93, 11.8%), SAH (18/114, 15.8%) and DAI (28.6%, 4/14). Most common mechanisms of injury associated with hyponatremia were ATV collisions, MVCs, pedestrian versus car, and NAT. Multivariate logistic regression found that only SDH increases the risk of hyponatremia by 1.74 (p=0.0234). Having a concussion alone was associated with less risk of hyponatremia (p=0.0088).

CONCLUSION
Overall incidence of hyponatremia in pediatric TBI patients is 10.6%. Subdural hematoma was the only factor identified so far to be significantly associated with hyponatremia.


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