Survival and Functional Outcome in Children with Traumatic Brain Injury Requiring Ventilatory Support: A Prospective Observational Pilot Study

Background In children, incidence of traumatic brain injury is high and identifying predictors of poor outcome can help clinicians make decisions in the acute phase of treatment. We thus planned to analyze the survival and functional outcome of children following traumatic brain injury. Our study included children (1-10 years of age) requiring ventilation and admitted to trauma intensive care unit of our hospital following traumatic brain injury. Our primary aim was to determine patient outcome using the modified Glasgow Outcome Scale at 3 months following hospital discharge. Our secondary objectives included patient outcome at 1 month following discharge and factors which may affect outcome. Methods Data (epidemiological, clinical, radiological data, and hospital course) of possible factors affecting survival and outcome of pediatric traumatic brain injury patients were collected. Patient outcome was determined using the modified Rankin Scale at the time of hospital discharge and modified Glasgow Outcome Scale at 1and 3 months following discharge. Results At the time of hospital admission, 60% children had a Glasgow Coma Scale score of 3 to 8, and were admitted with severe head injury. At the time of discharge, 30% children had good functional outcome, with 50 and 58% children being functionally independent at 1 and 3 months following discharge, respectively. Deranged serum sodium level was an independent predictor of poor neurological outcome on multivariate analysis (coefficient: -3.90 [-5.14 to -2.66, p < 0.001]). Conclusion Fifty-eight percent children, who were admitted to intensive care unit for mechanical ventilatory support, were functionally independent at the end of 3 months following discharge from the hospital, with modified Glasgow Outcome Scale score of 5 or "Normal." Deranged electrolytes result in secondary brain injury, thus contributing to poor long-term outcome. Effective electrolyte management is essential to improve outcome after traumatic brain injury in children.