Prognostic Factors of Glasgow Outcome Scale after Six Months in Children after Severe Traumatic Brain Injury
This study evaluates outcome determines prognostic factors for in children after severe traumatic brain injury. 109 children with severe traumatic brain injury (TBI), admitted to PICU of Kaunas Medical University Hospital during four-year period were included in the study. Median age was 10,4 years (range 0,2 – 18 years). As initial assessment tools the Glasgow Coma Score (GCS), Pediatric Trauma Score (PTS), Pediatric Index of Mortality 2 (PIM2) were calculated during the first hour after admission. Gender, age, injury mechanism, injury pattern, time until admission, existence of a multiple injuries, findings on initial CT, hematological and circulatory disorders, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) were evaluated and their impact on the outcome analyzed. Univariate and multivariate logistic regression was chosen for statistical analysis. The outcome after six months was assessed using Glasgow Outcome Scale (GOS). All children were treated according to the protocol of severe head trauma management. Survival rate was 86%. Outcomes were assessed after six month. Defining GOS 1,2 and 3 as poor outcome, and GOS 4 and 5 as good outcome, poor outcome consisted of 30 cases (27.6%) and good outcome – in 79 (72.4%) of patients. Two independent predictive factors for poor outcome after six months were found: PIM2 ≥7.9% (OR = 11.1; 95%, CI 2.2 – 56.5) and serum lactates 3.03 ≥ mmol/l (OR = 5.4; 95%, CI 1.0 – 28.1). Pediatric Index of Mortality2 and serum lactates are independent predictive factors of outcome in children after severe traumatic brain injury.