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

pubmed.ncbi.nlm.nih.gov

Meera Kotagal

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 younger than 18 years (2018-2019) transported from the scene, with elevated shock index pediatric-adjusted on arrival and head Abbreviated Injury Scale score of ≥3. Timing and volume of resuscitation products were assessed using χ 2t test, Fisher's exact t test, Kruskal-Wallis, and multivariable logistic regression analyses. Results: There were 142 patients with sTBI and 547 with non-sTBI injuries. Severe traumatic brain injury patients had lower initial hemoglobin (11.3 vs. 12.4, p < 0.001), greater initial international normalized ratio (1.4 vs. 1.1, p < 0.001), greater Injury Severity Score (25 vs. 5, p < 0.001), greater rates of ventilator (59% vs. 11%, p < 0.001) and intensive care unit (ICU) requirement (79% vs. 27%, p < 0.001), and more inpatient complications (18% vs. 3.3%, p < 0.001). Severe traumatic brain injury patients received more prehospital crystalloid (25% vs. 15%, p = 0.008), ≥1 crystalloid boluses (52% vs. 24%, p < 0.001), and blood transfusion (44% vs. 12%, p < 0.001) than non-sTBI patients. Among sTBI patients, receipt of ≥1 crystalloid bolus (n = 75) was associated with greater ICU need (92% vs.

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Article · Apr 2023 · 1 min read

In brief

Multicenter study of 142 pediatric severe TBI patients found that crystalloid bolus administration was associated with increased ICU requirements and complications compared to non-sTBI trauma patients. Findings suggest fluid resuscitation strategies in pediatric sTBI may need refinement to optimize outcomes.

Written by the GCMD Library team from the article.

Meera Kotagal

Statements in this article

Children with severe traumatic brain injury had lower initial hemoglobin (11.3 vs. 12.4, p < 0.001) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury had greater initial international normalized ratio (1.4 vs. 1.1, p < 0.001) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury had greater Injury Severity Score (25 vs. 5, p < 0.001) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury required ventilator support at greater rates (59% vs. 11%, p < 0.001) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury required intensive care unit admission at greater rates (79% vs. 27%, p < 0.001) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury had more inpatient complications (18% vs. 3.3%, p < 0.001) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury received more prehospital crystalloid (25% vs. 15%, p = 0.008) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury received one or more crystalloid boluses at greater rates (52% vs. 24%, p < 0.001) compared to children with non-sTBI injuries.
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Children with severe traumatic brain injury received blood transfusion at greater rates (44% vs. 12%, p < 0.001) compared to children with non-sTBI injuries.
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Among children with severe traumatic brain injury, receipt of one or more crystalloid boluses was associated with greater intensive care unit need (92% vs. the comparison group).
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