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The Modified Pilot Score For Pediatric Traumatic Brain Injury: Clinical Effect Of Hypertonic Saline On Intracranial Pressure Management
Akshita Kumar, Louis Carrillo, Cynthia Bell, Claudia Pedroza, Margaret Jackson, Fanni Cardenas, Max Skibber, *Charles S Cox, Jr.
University of Texas Houston Health Science Center, Houston, TX

Background (issue):
The Pediatric Intensity Level of Therapy (PILOT) score measures therapeutic intensity to manage intracranial pressure after traumatic brain injury (TBI). The original scoring system, however, did not account for graded hyperosmolar therapy, therefore a modified score has been proposed to reflect the use of escalating hypertonic saline (HTS) to treat TBI.
Retrospective review identified patients with TBI, using extra-cranial trauma patients as matched controls. Patients who received HTS were assigned a Modified PILOT (mPILOT) score. Differences between original and mPILOT scores were tested by sign rank test. Differences in PILOT scores across TBI groups and HTS were tested by Kruskal-Wallis test. Clinical outcomes between PILOT and mPILOT scores were correlated by Spearman's rank coefficients.
The mean of the mPILOT score significantly increased between the severe TBI and moderate TBI (p<0.0001) and matched controls (p<0.004). Patients who received HTS had an increase of 1.2 points in their mPILOT score (95% CI: 0.7-1.7, p=0.0001). Correlations between multiple clinical outcomes and PILOT scores was statistically significant. Furthermore, these correlations were strengthened when utilizing the mPILOT scores (Table 1).

Conclusions (implications for practice):
This cohort validates that the PILOT and mPILOT scores accurately discriminates TBI patients based on their injury severity. The mPILOT demonstrates stronger correlations with important clinical endpoints in the management of pediatric TBI in patients treated with HTS.

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