Neurocritical factors associated with mortality and functional recovery in pediatric trauma patients admitted to a tertiary PICU.

چکیده اصلی

PURPOSE: To identify early neuroprognostic factors associated with functional neurological outcome in pediatric trauma patients requiring PICU admission. The primary outcome was Glasgow Outcome Scale (GOS) at discharge and 6 months; secondary outcomes were in-hospital mortality and brain death. METHODS: We conducted a retrospective cohort study of 425 consecutive pediatric trauma admissions to a tertiary PICU from June 2014 to December 2021. Demographics, mechanisms of injury, admission severity scores (GCS, PRISM III, PTS), cranial CT findings, early laboratory markers, and key interventions were analyzed. Factors independently associated with mortality were assessed using multivariable logistic regression, and discrimination was evaluated with receiver operating characteristic analyses. RESULTS: Median age was 78 months and 64.2% were male. Falls and traffic accidents were the most common mechanisms. Overall mortality was 7.3% and was predominantly attributable to severe traumatic brain injury (29 of 31 deaths). Brain death occurred in 4.5%. At discharge, 349 of 425 patients (82.1%) had a good neurological outcome (GOS 4-5), whereas 76 (17.9%) had a poor outcome (GOS 1-3), including 31 in-hospital deaths (GOS 1). Among 394 hospital survivors, 6-month follow-up was available for 377 (95.7%); of these, 364 (96.6%) achieved good recovery and 13 (3.4%) had persistent poor outcomes. Among survivors with a poor outcome at discharge and available follow-up, 25 of 38 (65.8%) improved to a good outcome by six months. Seventeen survivors were lost to follow-up. Poor outcome (GOS 1 to 3) was associated with low admission GCS, cerebral edema or midline shift, and early physiologic stress including hyperglycemia and elevated lactate. Factors independently associated with mortality were inotropic support (OR 6.98), blood product administration (OR 6.52), albumin administration (OR 3.69), cerebral edema (OR 3.59), and admission GCS 8 or less (OR 6.82). PRISM III and PTS showed strong discrimination. CONCLUSION: In critically injured children, early neurological compromise and systemic instability that are identifiable during initial stabilization were the strongest factors associated with mortality and functional recovery, supporting neurofocused risk stratification and timely escalation of care.

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