International Journal of Endocrinology / 2015 / Article / Tab 4

Research Article

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.

StudyDesign Inclusion criteria (total ) ResultsComments

Melo et al. [3, 10] Retrospective cross-sectionalChildren 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 registryChildren 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-sectionalChildren 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 cohortChildren 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.

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