Age and Mortality in Pediatric Severe Traumatic Brain Injury

Results from an International Study

For the Investigators of the ADAPT Trial

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. Methods: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score = 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5–< 11, 11–18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan–Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. Results: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. Conclusions: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury—unrelated to AHT—that may lead to testable hypotheses in the future.

Original languageEnglish (US)
Pages (from-to)302-313
Number of pages12
JournalNeurocritical Care
Volume28
Issue number3
DOIs
StatePublished - Jun 1 2018

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Craniocerebral Trauma
Pediatrics
Glasgow Coma Scale
Mortality
Child Mortality
Intracranial Pressure
Motor Vehicles
Chi-Square Distribution
Hypothermia
Platelet Count
Proportional Hazards Models
Resuscitation
Accidents
Observational Studies
Analysis of Variance
Hemoglobins
Cohort Studies
Demography
Pregnancy
Traumatic Brain Injury

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Age and Mortality in Pediatric Severe Traumatic Brain Injury : Results from an International Study. / For the Investigators of the ADAPT Trial.

In: Neurocritical Care, Vol. 28, No. 3, 01.06.2018, p. 302-313.

Research output: Contribution to journalArticle

For the Investigators of the ADAPT Trial. / Age and Mortality in Pediatric Severe Traumatic Brain Injury : Results from an International Study. In: Neurocritical Care. 2018 ; Vol. 28, No. 3. pp. 302-313.
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abstract = "Background: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. Methods: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score = 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5–< 11, 11–18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan–Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. Results: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9{\%}, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. Conclusions: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury—unrelated to AHT—that may lead to testable hypotheses in the future.",
author = "{For the Investigators of the ADAPT Trial} and Ajit Sarnaik and Ferguson, {Nikki Miller} and O’Meara, {Am Iqbal} and Shruti Agrawal and Akash Deep and Sandra Buttram and Bell, {Michael J.} and Wisniewski, {Stephen R.} and Luther, {James F.} and Hartman, {Adam L.} and Vavilala, {Monica S.} and Sarah Mahoney and Deepak Gupta and John Beca and Laura Loftis and Kevin Morris and Lauren Piper and Anthony Slater and Karen Walson and Tellen Bennett and Todd Kilbaugh and O’Meara, {A. M.Iqbal} and Nathan Dean and Chima, {Ranjit S.} and Katherine Biagas and Enno Wildschut and Mark Peters and Kerri LaRovere and Joan Balcells and Courtney Robertson and Shira Gertz and Sian Cooper and Mark Wainwright and Sarah Murphy and John Kuluz and Warwick Butt and Nicole O’Brien and Neal Thomas and Simon Erickson and Samuel, {J. Mahil} and Rachel Agbeko and Richard Edwards and Ramakrishnan, {Kesava Ananth} and Margaret Winkler and Santiago Borasino and Joanne Natale and Christopher Giza and Mary Hilfiker and David Shellington and Nadeem Shafi",
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T1 - Age and Mortality in Pediatric Severe Traumatic Brain Injury

T2 - Results from an International Study

AU - For the Investigators of the ADAPT Trial

AU - Sarnaik, Ajit

AU - Ferguson, Nikki Miller

AU - O’Meara, Am Iqbal

AU - Agrawal, Shruti

AU - Deep, Akash

AU - Buttram, Sandra

AU - Bell, Michael J.

AU - Wisniewski, Stephen R.

AU - Luther, James F.

AU - Hartman, Adam L.

AU - Vavilala, Monica S.

AU - Mahoney, Sarah

AU - Gupta, Deepak

AU - Beca, John

AU - Loftis, Laura

AU - Morris, Kevin

AU - Piper, Lauren

AU - Slater, Anthony

AU - Walson, Karen

AU - Bennett, Tellen

AU - Kilbaugh, Todd

AU - O’Meara, A. M.Iqbal

AU - Dean, Nathan

AU - Chima, Ranjit S.

AU - Biagas, Katherine

AU - Wildschut, Enno

AU - Peters, Mark

AU - LaRovere, Kerri

AU - Balcells, Joan

AU - Robertson, Courtney

AU - Gertz, Shira

AU - Cooper, Sian

AU - Wainwright, Mark

AU - Murphy, Sarah

AU - Kuluz, John

AU - Butt, Warwick

AU - O’Brien, Nicole

AU - Thomas, Neal

AU - Erickson, Simon

AU - Samuel, J. Mahil

AU - Agbeko, Rachel

AU - Edwards, Richard

AU - Ramakrishnan, Kesava Ananth

AU - Winkler, Margaret

AU - Borasino, Santiago

AU - Natale, Joanne

AU - Giza, Christopher

AU - Hilfiker, Mary

AU - Shellington, David

AU - Shafi, Nadeem

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. Methods: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score = 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5–< 11, 11–18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan–Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. Results: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. Conclusions: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury—unrelated to AHT—that may lead to testable hypotheses in the future.

AB - Background: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. Methods: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score = 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5–< 11, 11–18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan–Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates. Results: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts. Conclusions: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury—unrelated to AHT—that may lead to testable hypotheses in the future.

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