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Does hypertension at initial presentation adversely affect outcomes in pediatric traumatic brain injury?

Abstract：

BACKGROUND:Adults with traumatic brain injury (TBI) who present hypertensive suffer worse outcomes and increased mortality compared to normotensive patients. The purpose of this study is to determine if age-adjusted hypertension on presentation is associated with worsened outcomes in pediatric TBI. METHODS:A retrospective chart review was conducted on pediatric patients with severe TBI admitted to a single system pediatric tertiary care center. The primary outcome was mortality. Secondary outcomes included length of stay, need for neurosurgical intervention, duration of mechanical ventilation, and the need for inpatient rehabilitation. RESULTS:Of 150 patients, 70% were hypertensive and 30% were normotensive on presentation. Comparing both groups, no statistically significant differences were noted in mortality (13.3% for both groups), need for neurosurgical intervention (51.4% vs 48.8%, p = 0.776), length of stay (6 vs 8 days, p = 0.732), duration of mechanical ventilation (2 vs 3 days, p = 0.912), or inpatient rehabilitation rates (48.6% vs 48.9%, p = 0.972). In comparing just the hypertensive patients, there was a trend toward increased mortality in the 95th and 99th percentile groups at 15.8% and 14.1%, versus the 90th percentile group at 6.7% but the difference was not statistically significant (p = 0.701). CONCLUSIONS:Contrary to the adult literature, pediatric patients with severe TBI and hypertension on presentation do not appear to have worsened outcomes compared to those who are normotensive. However, a trend toward increased mortality did exist at extremes of age adjusted hypertension. Larger scale studies are needed to validate these findings. STUDY TYPE:Retrospective cohort study LEVEL OF EVIDENCE: III.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Freeman AD,Fitzgerald CA,Baxter KJ,Neff LP,McCracken CE,Bryan LN,Morsberger JL,Zahid AM,Santore MT

doi

10.1016/j.jpedsurg.2019.06.008

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

702-706

issue

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(19)30405-1

journal_volume

pub_type

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Does hypertension at initial presentation adversely affect outcomes in pediatric traumatic brain injury?