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Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI

Aims and Objectives: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Our aim was to determine the mode of death for children who died with sTBI in a Pediatric Critical Care Unit (PCCU) and evaluate factors associated with mortality. Methods: We performed a retrospecti...

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Autores principales: Baird, Talia D., Miller, Michael R., Cameron, Saoirse, Fraser, Douglas D., Tijssen, Janice A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710712/
https://www.ncbi.nlm.nih.gov/pubmed/34966706
http://dx.doi.org/10.3389/fped.2021.793008
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author Baird, Talia D.
Miller, Michael R.
Cameron, Saoirse
Fraser, Douglas D.
Tijssen, Janice A.
author_facet Baird, Talia D.
Miller, Michael R.
Cameron, Saoirse
Fraser, Douglas D.
Tijssen, Janice A.
author_sort Baird, Talia D.
collection PubMed
description Aims and Objectives: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Our aim was to determine the mode of death for children who died with sTBI in a Pediatric Critical Care Unit (PCCU) and evaluate factors associated with mortality. Methods: We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥ 12) with sTBI (Glasgow Coma Scale [GCS] ≤ 8 and Maximum Abbreviated Injury Scale ≥ 4) admitted to a Canadian PCCU (2000–2016). We analyzed mode of death, clinical factors, interventions, lab values within 24 h of admission (early) and pre-death (48 h prior to death), and reviewed meeting notes in patients who died in the PCCU. Results: Of 195 included patients with sTBI, 55 (28%) died in the PCCU. Of these, 31 (56%) had a physiologic death (neurologic determination of death or cardiac arrest), while 24 (44%) had withdrawal of life-sustaining therapies (WLST). Median (IQR) times to death were 35.2 (11.8, 86.4) hours in the physiologic group and 79.5 (17.6, 231.3) hours in the WLST group (p = 0.08). The physiologic group had higher partial thromboplastin time (PTT) within 24 h of admission (p = 0.04) and lower albumin prior to death (p = 0.04). Conclusions: Almost half of sTBI deaths in the PCCU were by WLST. There was a trend toward a longer time to death in these patients. We found few early and late (pre-death) factors associated with mode of death, namely higher PTT and lower albumin.
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spelling pubmed-87107122021-12-28 Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI Baird, Talia D. Miller, Michael R. Cameron, Saoirse Fraser, Douglas D. Tijssen, Janice A. Front Pediatr Pediatrics Aims and Objectives: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Our aim was to determine the mode of death for children who died with sTBI in a Pediatric Critical Care Unit (PCCU) and evaluate factors associated with mortality. Methods: We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥ 12) with sTBI (Glasgow Coma Scale [GCS] ≤ 8 and Maximum Abbreviated Injury Scale ≥ 4) admitted to a Canadian PCCU (2000–2016). We analyzed mode of death, clinical factors, interventions, lab values within 24 h of admission (early) and pre-death (48 h prior to death), and reviewed meeting notes in patients who died in the PCCU. Results: Of 195 included patients with sTBI, 55 (28%) died in the PCCU. Of these, 31 (56%) had a physiologic death (neurologic determination of death or cardiac arrest), while 24 (44%) had withdrawal of life-sustaining therapies (WLST). Median (IQR) times to death were 35.2 (11.8, 86.4) hours in the physiologic group and 79.5 (17.6, 231.3) hours in the WLST group (p = 0.08). The physiologic group had higher partial thromboplastin time (PTT) within 24 h of admission (p = 0.04) and lower albumin prior to death (p = 0.04). Conclusions: Almost half of sTBI deaths in the PCCU were by WLST. There was a trend toward a longer time to death in these patients. We found few early and late (pre-death) factors associated with mode of death, namely higher PTT and lower albumin. Frontiers Media S.A. 2021-12-13 /pmc/articles/PMC8710712/ /pubmed/34966706 http://dx.doi.org/10.3389/fped.2021.793008 Text en Copyright © 2021 Baird, Miller, Cameron, Fraser and Tijssen. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Baird, Talia D.
Miller, Michael R.
Cameron, Saoirse
Fraser, Douglas D.
Tijssen, Janice A.
Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
title Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
title_full Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
title_fullStr Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
title_full_unstemmed Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
title_short Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
title_sort clinical and physiologic factors associated with mode of death in pediatric severe tbi
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710712/
https://www.ncbi.nlm.nih.gov/pubmed/34966706
http://dx.doi.org/10.3389/fped.2021.793008
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