Inpatient outcomes in pediatric diffuse axonal injury: high mortality in severe TBI and limited impact of Grade III DAI.

IF 1.3 4区医学 Q4 CLINICAL NEUROLOGY

Child's Nervous System Pub Date : 2025-03-25 DOI:10.1007/s00381-025-06802-8

Sean Inzerillo, Mert Karabacak, Peter Morgenstern, Konstantinos Margetis

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引用次数: 0

Abstract

Purpose: This study investigates key prognostic factors influencing morbidity and mortality in pediatric diffuse axonal injury (DAI) using nationally collected data from the American College of Surgeons (ACS) Trauma Quality Program (TQP) to inform clinical practice and future research.

Methods: The ACS-TQP database (2019-2021) was analyzed for pediatric DAI cases, excluding those with intracranial hemorrhages or pre-admission deaths. Demographics and clinical characteristics were compared across age groups (0-3, 4-12, 13-17), and multivariate regression identified predictors of mortality, complications, intensive care unit (ICU) stay, and ventilator duration.

Results: Among 533 pediatric DAI patients, the mortality rate was 20.3%, highest in the 0-3 age group (29%) compared to 4-12 (20.8%) and 13-17 (19%) (p = 0.016). Severe traumatic brain injury (TBI) (Glasgow Coma Scale 3-8) and systolic blood pressure < 90 mm Hg were strong mortality predictors (OR 56.9, p < 0.001; OR 9.2, p < 0.001). Prolonged coma (> 24 h) increased mortality odds (OR 7.4, p = 0.018) but did not meet the adjusted threshold. Complications occurred in 16.3% of patients, with severe TBI increasing complication odds (OR 4.1, p = 0.005). ICU stay was longer with surgery (p < 0.001), and prolonged coma predicted longer ventilation (p < 0.001). Grade III DAI was not linked to worse outcomes.

Conclusion: Severe TBI and hypotension were significant predictors of mortality and morbidity in pediatric DAI. Grade III DAI was not associated with worse outcomes, highlighting the need for further research to refine prognostic factors.

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儿童弥漫性轴索损伤的住院结果：严重TBI的高死亡率和III级DAI的有限影响。

目的：本研究利用美国外科医师学会（ACS）创伤质量计划（TQP）收集的全国数据，探讨影响儿童弥漫性轴索损伤（DAI）发病率和死亡率的关键预后因素，为临床实践和未来研究提供依据。方法：分析ACS-TQP数据库（2019-2021）的儿童DAI病例，不包括颅内出血或入院前死亡的病例。比较各年龄组（0-3岁、4-12岁、13-17岁）的人口统计学和临床特征，并通过多因素回归确定死亡率、并发症、重症监护病房（ICU）住院时间和呼吸机使用时间的预测因素。结果：533例儿童DAI患者死亡率为20.3%，0-3岁死亡率最高（29%），4-12岁死亡率为20.8%，13-17岁死亡率为19% （p = 0.016）。严重创伤性脑损伤（TBI）（格拉斯哥昏迷量表3-8）和24小时收缩压)增加了死亡率（OR 7.4, p = 0.018），但未达到调整阈值。16.3%的患者出现并发症，严重的TBI增加了并发症的发生率（OR 4.1, p = 0.005）。结论：严重TBI和低血压是儿童DAI死亡率和发病率的重要预测因素。III级DAI与较差的预后没有关联，这表明需要进一步研究来完善预后因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Child's Nervous System 医学-临床神经学

CiteScore

3.00

自引率

7.10%

发文量

322

审稿时长

3 months

期刊介绍： The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.