Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay

Table 4

Previous studies reporting on hyperglycemia as a predictor for poor outcomes in pediatric traumatic brain injury.

Study	Design	Inclusion criteria (total )	Results	Comments
Melo et al. [3, 10]	Retrospective cross-sectional	Children with severe TBI (GCS ≤8).; Mean age of 7 years ().	Hyperglycemia ≥200 mg/dL is an independent predictor for mortality—OR 6.14 (95% CI 2.25–16.73).	A new scale was proposed; this included age group, GCS, temperature, blood glucose levels, and prothrombin time.
Cochran et al. [9]	Retrospective review	Children admitted with a head regional AIS ≥3. Median age of 4 years ().	Admission glucose had adjusted OR for head-injury related death of 1.01 (95% CI 1.003–10.23).	On multivariate analysis, GCS was also an independent predictor for head-injury related death.
Smith et al. [13]	Retrospective review of a prospectively collected pediatric neurotrauma registry	Children admitted with severe TBI (GCS ≤8). Mean age of 81 months ().	Mean glucose concentrations in the early period (<48 hours) were similar in children with favorable and unfavorable outcomes. Hyperglycemia in the late period (49–168 hours) was associated with unfavorable GOS at 6 months.	As part of the protocol, if serum glucose ≥70 mg/dL, glucose administration was avoided for 48 hours after TBI.
Seyed Saadat et al. [14]	Retrospective cross-sectional	Children with severe TBI (GCS ≤8), admitted to ED within 12 hours of injury.; Median age of 13 years ().	Persistent hyperglycemia during the first 2 and first 3 days had adjusted ORs for mortality of 2.84 (95% CI 0.89–9.06) and 11.11 (95% CI 2.95–41.71), respectively.	Persistent hyperglycemia is an independent predictor of mortality.
Elkon et al. [12]	Retrospective cohort	Children with moderate (GCS 9–12) and severe TBI (GCS 3–8). Mean age (of severe hyperglycemia group) of 6.1 years ().	Severe blood glucose elevation (blood glucose >200 mg/dL) had increased adjusted OR of 3.5 for poor GOS, compared with mild glucose elevation (glucose 110–160 mg/dL).	Severe blood glucose elevation was independently associated with poor outcome.
Parish and Webb [15]	Retrospective case control	Children admitted with GCS of 3–10, between 24 months and 12 years.; Mean age of (of cases) 7 years (, 37 controls).	The hyperglycemic response was more common among those with head trauma (40% compared to controls (5%) but within the head trauma group, the level of hyperglycemia was not associated with death or need for extended care).	GCS on admission was a significant prognostic indicator.; In this study, authors conclude that the hyperglycemia is transient and does not warrant treatment with insulin.