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Factors predicting outcomes in surgically treated pediatric traumatic brain injury

1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
2 Neurosurgery Division, Department of Surgery, National University Health System, Singapore
3 Yong Loo Lin School of Medicine, National University of Singapore; Neurosurgery Division, Department of Surgery, National University Health System, Singapore

Correspondence Address:
Sean Wei Yi Lee,
Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11 NUHS Tower Block, Singapore 119 228
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_2_19

Introduction: Traumatic brain injury (TBI) is a common presentation to the pediatric emergency department. Understanding factors that predict outcomes will be useful in clinical decision-making and prognostication. The objective of this study was to identify important clinical parameters predictive of outcomes in pediatric TBI patients who underwent surgery. Materials and Methods: This retrospective study included 43 pediatric TBI patients who underwent surgery from January 2011 to January 2017. Clinical parameters, including presenting signs and symptoms, mechanism of injury, intracranial pressure (ICP), need for inotropes, and computed tomography findings were collected. Outcomes were assessed using the Glasgow outcome score (GOS) based on the latest follow-up. Outcomes were divided into favorable (GOS 4–5) and unfavorable (GOS 1–3). Results: Surgery was performed in 43 patients. The mean age was 9.6 ± 4.9. The mean follow-up period was 31 weeks. Thirty (70%) patients had favorable outcome and 13 (30%) had unfavorable outcome. On univariate analysis, mechanism of injury, vomiting, Glasgow coma scale score, pupil size and reactivity, hypotension, inotropic use, need for blood transfusion, and raised ICP (all P < 0.005) were significantly associated with outcomes. On step-wise logistic regression, only raised ICP (odds ratio [OR] = 35.6, P = 0.008) and hypotension (OR = 26.1, P = 0.01) were found to be statistically significant. Conclusion: The present study suggests that the majority of pediatric TBI patients who required neurosurgical intervention have favorable outcomes. Closer attention should be paid to raised ICP and hypotension as they were strong predictors of unfavorable outcomes. These findings also help manage expectations of patients' family and clinicians.

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