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Timely Hemodynamic Resuscitation and Outcomes in Severe Pediatric Traumatic Brain Injury
Nithya Kannan, MD, Jin Wang, PhD, Douglas F. Zatzick, MD, Richard G. Ellenbogen, MD, Linda Ng Boyle, PhD, Pamela H. Mitchell, PhD, Frederick P. Rivara, MD, MPH, Ali Rowhani-Rahbar, MD, MPH, PhD and Monica S. Vavilala, MD, University of Washington, Seattle WA; Richard B. Mink, MD, MACM, Harbor-UCLA and Los Angeles BioMedical Research Institute, Torrance CA; Mark S. Wainwright, MD, PhD, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago IL; Jonathan I. Groner, MD, The Ohio State University College of Medicine, Columbus OH; Michael J. Bell, MD, University of Pittsburgh, Pittsburgh PA; Christopher C. Giza, MD, Mattel Children's Hospital, UCLA, Los Angeles CA

Abstract:
OBJECTIVES: Early resuscitation may improve outcomes in pediatric traumatic brain injury (TBI). We examined the association between timely treatment of hypotension and hypoxia during early care and outcomes in children with severe TBI. METHODS: Hypotension was defined as systolic blood pressure less than 70 + 2 (age in years), and hypoxia was defined as PaO2 < 60 mmHg or oxygen saturation < 90% in accordance with the 2003 Brain Trauma Foundation guidelines. Timely treatment of hypotension and hypoxia during early care was defined as the treatment within 30 minutes of a documented respective episode in the prehospital or emergency department locations. Two hundred and thirty-six medical records of children under 18 years with severe TBI from five regional pediatric trauma centers were examined. Main outcomes were discharge mortality and Glasgow Outcome Scale (GOS) score. RESULTS: Hypotension occurred in 26% (60/234) during early care and was associated with in-hospital mortality (23.3% vs 8.6%; p = 0.01). Timely treatment of hypotension during early care occurred in 92% (55/60) by use of intravenous fluids, blood products or vasopressors and was associated with reduced discharge mortality (aRR 0.46; 95% CI 0.24, 0.90) and less likelihood of poor discharge GOS (aRR 0.54; 95% CI 0.39, 0.76) when compared to children with hypotension who were not treated in a timely manner. Early hypoxia occurred in 17% (41/236) and all patients received timely oxygen treatment. CONCLUSIONS: Timely resuscitation during early care was common and associated with lower discharge mortality and favorable GOS in severe pediatric TBI.
Objective:
At the end of this activity, I will be able to discuss and demonstrate that timely hemodynamic resuscitation during early care would lead to better discharge outcomes in children with severe traumatic brain injury.
Objective Content: Previous work by Zebrack and colleagues showed that early resuscitation improved discharge outcomes in moderate to severe pediatric traumatic brain injury. We focus on the association between timely resuscitation during early care and discharge outcomes in children with severe Traumatic brain injury. Reference: Zebrack M, Dandoy C, Hansen K et al. Early Resuscitation of Children With Moderate-to-Severe Traumatic Brain Injury. Pediatrics. 2009; 124(1); 56-64.


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