New Functional Impairment After Hospital Discharge by Traumatic Brain Injury Mechanism in Younger Than 3 Years Old Admitted to the PICU in a Single Center Retrospective Study.

Autor:	McNamara CR; Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA., Kalinowski A; Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA., Horvat CM; Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA., Gaines BA; Department of Pediatric Surgery, University of Pittsburgh, Pittsburgh, PA., Richardson WM; Department of Pediatric Surgery, University of Pittsburgh, Pittsburgh, PA., Simon DW; Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA., Kochanek PM; Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA., Berger RP; Department of Child Advocacy, University of Pittsburgh, Pittsburgh, PA., Fink EL; Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Mar 01; Vol. 25 (3), pp. 250-258. Date of Electronic Publication: 2023 Dec 13.
DOI:	10.1097/PCC.0000000000003417
Abstrakt:	Objectives: Children who suffer traumatic brain injury (TBI) are at high risk of morbidity and mortality. We hypothesized that in patients with TBI, the abusive head trauma (AHT) mechanism vs. accidental TBI (aTBI) would be associated with higher frequency of new functional impairment between baseline and later follow-up. Design: Retrospective single center cohort study. Setting and Patients: Children younger than 3 years old admitted with TBI to the PICU at a level 1 trauma center between 2014 and 2019. Interventions: None. Measurements and Main Results: Patient characteristics, TBI mechanism, and Functional Status Scale (FSS) scores at baseline, hospital discharge, short-term (median, 10 mo [interquartile range 3-12 mo]), and long-term (median, 4 yr [3-6 yr]) postdischarge were abstracted from the electronic health record. New impairment was defined as an increase in FSS greater than 1 from baseline. Patients who died were assigned the highest score (30). Multivariable logistic regression was performed to determine the association between TBI mechanism with new impairment. Over 6 years, there were 460 TBI children (170 AHT, 290 aTBI), of which 13 with AHT and four with aTBI died. Frequency of new impairment by follow-up interval, in AHT vs. aTBI patients, were as follows: hospital discharge (42/157 [27%] vs. 27/286 [9%]; p < 0.001), short-term (42/153 [27%] vs. 26/259 [10%]; p < 0.001), and long-term (32/114 [28%] vs. 18/178 [10%]; p < 0.001). Sensory, communication, and motor domains were worse in AHT patients at the short- and long-term timepoint. On multivariable analysis, AHT mechanism was associated with greater odds (odds ratio [95% CI]) of poor outcome (death and new impairment) at hospital discharge (4.4 [2.2-8.9]), short-term (2.7 [1.5-4.9]), and long-term timepoints (2.4 [1.2-4.8]; p < 0.05). Conclusions: In patients younger than 3 years old admitted to the PICU after TBI, the AHT mechanism-vs. aTBI-is associated with greater odds of poor outcome in the follow-up period through to ~5 years postdischarge. New impairment occurred in multiple domains and only AHT patients further declined in FSS over time. Competing Interests: Drs. McNamara, Kochanek, and Fink received support for article research from the National Institutes of Health (NIH). Dr. McNamara received funding from the NIH (5T32HD040686-22). Dr. Horvat’s institution received funding from the National Institute of Child Health and Human Development. Drs. Kochanek’s and Fink’s institution received funding from the NIH. Dr. Berger’s institution received funding for expert testimony. Dr. Fink’s institution received funding from the Neurocritical Care Society; they received funding from the American Board of Pediatrics. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu