학술논문
Crystalloid Volume is Associated with Short Term Morbidity in Children with Severe Traumatic Brain Injury: An Eastern Association for the Surgery of Trauma Multicenter Trial Post-Hoc Analysis
Document Type
Academic Journal
Author
MacArthur, Taleen A.; Vogel, Adam M.; Glasgow, Amy E.; Moody, Suzanne; Kotagal, Meera; Williams, Regan F.; Kayton, Mark L.; Alberto, Emily C.; Burd, Randall S.; Schroeppel, Thomas J.; Baerg, Joanne E.; Munoz, Amanda; Rothstein, William B.; Boomer, Laura A.; Campion, Eric M.; Robinson, Caitlin; Nygaard, Rachel M.; Richardson, Chad J.; Garcia, Denise I.; Streck, Christian J.; Gaffley, Michaela; Petty, John K.; Ryan, Mark; Pandya, Samir; Russell, Robert T.; Yorkgitis, Brian K.; Mull, Jennifer; Pence, Jeffrey; Santore, Matthew T.; Klinkner, Denise B.; Safford, Shawn D.; Trevilian, Tanya; Jensen, Aaron R.; Mooney, David P.; Ketha, Bavana; Dassinger, Melvin S., III; Goldenberg-Sandau, Anna; Falcone, Richard A.; Polites, Stephanie F.
Source
Journal of Trauma and Acute Care Surgery. Apr 19, 2023
Subject
Language
English
ISSN
2163-0755
Abstract
OBJECTIVE: This study examined differences in clinical and resuscitation characteristics between injured children with and without severe traumatic brain injury (sTBI) and aimed to identify resuscitation characteristics associated with improved outcomes following sTBI. METHODS: This is a post-hoc analysis of a prospective, observational study of injured children <18 years old (2018-2019) transported from the scene, with elevated shock index pediatric-adjusted on arrival and head Abbreviated Injury Scale (AIS) score ≥ 3. Timing and volume of resuscitation products were assessed using Chi-squared t-test, Fisherʼs exact t-test, Kruskal-Wallis, and multivariable logistic regression analyses. RESULTS: There were 142 patients with sTBI and 547 with non-sTBI injuries. sTBI patients had lower initial hemoglobin (11.3 vs. 12.4, p < .001), greater initial INR (1.4 vs. 1.1, p < .001), greater ISS (25 vs. 5, p < .001), greater rates of ventilator (59% vs. 11%, p < .001) and ICU requirement (79% vs. 27%, p < .001), and more inpatient complications (18% vs. 3.3%, p < .001). sTBI patients received more pre-hospital crystalloid (25% vs. 15 %, p = .008), ≥1 crystalloid boluses (52% vs.24%, p < .001), and blood transfusion (44 % vs.12%, p < .001) than non-sTBI patients. Among sTBI patients, receipt of ≥1 crystalloid bolus (n = 75) was associated with greater ICU need (92% vs.64%, p < .001), longer median ICU (6 vs.4 days, p = 0.027) and hospital stay (9 vs.4 days, p < .001), and more in-hospital complications (31% vs. 7.5%, p = 0.003) than those who received <1 bolus (n = 67). These findings persisted after adjustment for injury severity score (OR 3.4-4.4, all p < .010). CONCLUSION: Pediatric trauma patients with sTBI received more crystalloid than those without sTBI despite having a greater INR at presentation and more frequently requiring blood products. Excessive crystalloid may be associated with worsened outcomes, including in-hospital mortality, seen among pediatric sTBI patients who received ≥1 crystalloid bolus. Further attention to a crystalloid sparing, early transfusion approach to resuscitation of children with sTBI is needed. LEVEL OF EVIDENCE: IVRetrospective post-hoc analysis of a prospective observational cohort study