A Retrospective Cohort Study of Traumatic Brain Injury in Children: A Single-Institution Experience and Determinants of Neurologic Outcome

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Fig. 3.

Comparison of different scoring systems of the TBI patients according to the presence of early, and late enteral feeding

Parameter	Enteral feeding		p
	<48th hour of hospitalization (n=65)	>48th hour of hospitalization (n=25)
PRISM	5 (0–25)	6 (1–27)	0.124
PDR (%)	1.6 (0.5–59)	2.1 (0.4–52.8)	0.296
PIM3	2 (0.7–27)	2.2 (0.9–11)	0.182
Pediatric Trauma Score	10 (−1–12)	9 (1–12)	0.139
Injury severity score	5 (1–50)	10 (2–41)	0.001
GCS	13 (2–15)	13 (5–15)	0.985
GOS at discharge	5 (1–5)	5 (3–5)	0.340
GOS at 3rd month	5 (1–5)	5 (3–5)	0.238
Favorable GOS at discharge	46 (70.8)	15 (60)	0.327
Favorable GOS at 3rd month	50 (76.9)	16 (64)	0.214

Comparison of demographic and clinical properties between patients with favorable outcome and disability according to Glasgow Outcome Score (GOS) 3 months after TBI

Parameter	GOS at 3rd month		p
	GOS=5 (n=66)	GOS≤4 (n=24)
Age	4.9 (0.3–17.5)	6.1 (0.2–17.5)	0.942
Gender (female)	29 (43.9)	8 (33.3)	0.366
Multisystemic trauma	37 (56.1)	19 (79.2)	0.046
Trauma localization in multisystemic trauma
Extremity trauma	20 (30.3)	6 (25)	0.624
Pelvic trauma	6 (9.1)	2 (8.3)	0.911
Thorax trauma	14 (21.2)	16 (66.7)	0.001
Abdominal trauma	12 (18.2)	9 (37.5)	0.054
Facial trauma	17 (25.8)	6 (25)	0.942
Vertebral trauma	7 (10.6)	1 (4.2)	0.342
Altered consciousness	37 (56.1)	22 (91.7)	0.002
Seizure	5 (7.6)	11 (45.8)	0.001
CT/MRI findings
Skull fracture	46 (69.7)	12 (50)	0.084
Brain contusion	26 (39.4)	23 (95.8)	0.001
Subarachnoid hemorrhage	4 (6.1)	5 (20.8)	0.039
Subdural hemorrhage	9 (13.6)	10 (41.7)	0.004
Epidural hemorrhage	9 (13.6)	5 (20.8)	0.405
Intraparenchymal hemorrhage	7 (10.6)	6 (25)	0.086
Brain edema	31 (47)	13 (54.2)	0.546
Diffuse axonal injury	0	5 (28)	0.001
Shock treatment in ED	5 (7.6)	5 (20.8)	0.077
Inotropic drug in ED	1 (1.5)	3 (12.5)	0.025
Blood products in 48 h	16 (24.2)	16 (66.7)	0.001
Cranial surgery in 24 h	4 (6.1)	6 (25)	0.011
Other surgery in 24 h	11 (16.7)	6 (25)	0.372
CPR in the first 24h of hospitalization	0	3 (12.5)	0.003
MV in the first 24h of hospitalization	1 (1.5)	15 (62.5)	0.001
Nosocomial infections	2 (3)	12 (50)	0.001
PICU stay	2 (1–12)	9 (2–47)	0.001
Length of hospitalization	5 (2–33)	16.5 (6–60)	0.001
MV duration	1 (1–4)	5 (1–28)	0.061
PRISM	4 (0–18)	16 (4–27)	0.001
PDR (%)	1.5 (0.4–25.5)	15.5 (0–59)	0.001
PIM3	1.8 (0.7–8)	6.8 (1.2–27)	0.001
Pediatric Trauma score (PTS)	10 (6–12)	5 (−1–11)	0.001
Injury severity score (ISS)	5 (1–24)	15 (4–50)	0.001
GCS at admission	15 (2–15)	8 (4–15)	0.001

Comparison of demographic and clinical parameters between patients according to the presence of early, and late enteral feeding

	<48th hour of hospitalization (n=65)	>48th hour of hospitalization (n=25)	p
Age (year), median	5.08 (0.25–17.5)	7.58 (0.67–17.5)	0.063
Gender (female)	25 (38.5)	12 (48)	0.410
Trauma localization
Multisystemic trauma	32 (49.2)	24 (96)	0.001
Extremity trauma	11 (16.9)	15 (60)	0.001
Pelvic trauma	1 (1.5)	7 (28)	0.001
Thorax trauma	20 (30.8)	10 (40)	0.405
Abdominal trauma	8 (12.3)	13 (52)	0.001
Facial trauma	11 (16.9)	12 (48)	0.002
Vertebral trauma	4 (6.2)	4 (16)	0.142
CT/MRI findings
Skull fracture	40 (61.5)	18 (72)	0.353
Brain contusion	7 (10.8)	3 (12)	0.868
Subarachnoid hemorrhage	5 (7.7)	4 (16)	0.239
Subdural hemorrhage	15 (23.1)	4 (16)	0.461
Epidural hemorrhage	11(16.9)	3 (12)	0.564
Intraparenchymal hemorrhage	10 (15.4)	3 (12)	0.682
Brain edema	31 (47.7)	13 (52)	0.714
Diffuse axonal injury	5 (7.7)	0	0.067
First 24 hours
Blood products	19 (29.2)	13 (52)	0.043
Cranial surgery	8 (12.3)	2 (8)	0.560
Other surgery	6 (9.2)	11 (44)	0.001
CPR	1 (1.5)	2 (8)	0.128
Mechanical ventilation	11 (16.9)	5(20)	0.732
Nosocomial infection	10 (15.4)	4 (16)	0.943
PICU stay	3 (1–28)	5 (1–47)	0.272
Length of hospitalization	5 (2–43)	10 (5–60)	0.001

The causes, locations, and clinical features of traumatic brain injury in 90 children

Causes	n	%	Locations	n	%
Road traffic accidents	39	43.3	Outdoor	67	74.4
Passenger	12	13.3	Home	21	23.3
Pedestrian	27	30	School	2	2.2
Fall from height	34	37.8	CT/MRI findings	n	%
Cyclist	9	10	Skull fracture	58	64.4
Falling object	4	4.4	Brain edema	44	48.9
Basic fall	3	3.3	Subdural hemorrhage	19	21.1
Other	1	1.1	Epidural hemorrhage	14	15.6
Sign and symptoms	n	%	Intraparenchymal hemorrhage	13	14.4
Altered consciousness	59	65.6	Brain contusion	10	11.1
Nausea/Vomiting	28	31.1	Subarachnoid hemorrhage	9	10
Seizure	16	17.8	Diffuse axonal injury	5	5.6
Headache	9	10	Minimal brain edema	5	5.6
Amnesia	2	2.2
Asymptomatic	6	6.7

Multiple logistic regression analysis of variables associated with outcome according to the 3rd month GOS in traumatic brain injury patients

Variables	B	S.E.	P	OR (95% CI)
Diffuse axonal injury	−0.281	0.243	0.001	2.62 (1.83–3.74)
CPR in the first 24h of hospitalization	−0.339	0.503	0.005	1.62 (1.13–2.74)
PIM3	−0.285	0.023	0.023	1.56 (0.40–6.19)