| Brain injury is a common and devastating event in the United States impacting both the adult and the pediatric populations. In the pediatric population there are over 100,000 children under the age of 15 treated annually for neurological trauma with many suffering significant long-term disability and death. There are extensive data and research evaluating the impact of cerebral trauma in the adult population. Optimization of cerebral perfusion pressure (CPP) has gained recognition as a therapeutic endpoint in the management of brain-injured adults. This study will evaluate the relationship between CPP and intracranial pressure (ICP) in children with severe traumatic brain injury. This study focuses on the effectiveness of perfusion of injured neurons and the relationship to outcome.; Fifty-five children, aged 1.5 to 15 years, admitted for severe blunt head trauma (Glasgow Coma Score ≤8) were retrospectively studied looking at systolic blood pressure, heart rate, temperature, mean arterial pressure, intracranial pressure and cerebral perfusion pressure as an indicator of outcome as measured by the DELTA injury and disability score. Demographic data collected included age, sex, ethnicity, and admission Glasgow Coma Scale score. Data were analyzed using the SAS software. Results indicate that the first 48 hours after an injury is the critical period to influence outcome with mean arterial pressure, intracranial pressure and cerebral perfusion pressure significant indicators of outcome (p ≤ 0.0005).; When subjects were divided into two groups, children who died and children who survived, temperature was significant (p ≤ 0.0005) for the first four days post injury. Temperature continued to maintain significance when subjects were divided into survivors with poor outcome and good outcome. The relationship between outcome and therapeutic interventions is unclear and requires further evaluation in a larger prospective study. |
