738: CRITICAL CARE UTILIZATION AND OUTCOMES IN PEDIATRIC MODERATE TRAUMATIC BRAIN INJURY

Abstract

Introduction: Patients with moderate traumatic brain injury (mTBI) have outcomes that range from good functional recovery to death. We compared neurocritical care utilization of patients with high Glasgow Coma Scale (GCS) mTBI (hmTBI, GCS 11-13) and low GCS mTBI (lmTBI, GCS 9-10), and functional outcomes of patients with mTBI and severe TBI (sTBI, GCS < 9) 3-months post injury. We hypothesize that patients with lmTBI have higher neurocritical care needs and worse outcomes than patients with hmTBI and similar to patients with sTBI. Methods: We performed a dual continent prospective observational study from June 2018 – April 2022 among children (age < 16 years) with mTBI and sTBI admitted to 33 pediatric intensive care units in the Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN) and LARed: Red Colaborativa Pediatrica de Latinoamerica. We assessed functional outcomes using the Glasgow Outcome Scale – Extended Pediatric Revision (GOS-E Peds, scale 1-8, 1 = upper good recovery, 8 = death). Results: We analyzed 396 children with mTBI (24%) and sTBI (70%). In-hospital mortality was 0% and 12%, respectively. Compared with mTBI, the sTBI group was more likely to be mechanically ventilated in the first hour of ICU admission (76.9% vs 28.7%, p< 0.001), have a longer duration of mechanical ventilation (5.00, [interquartile range (IQR) 4.00, 8.50] vs 3.00 [IQR 1.5, 6.00] days, p 0.023), and longer duration of ICU stay (8.00 [IQR 4.00, 13.5] vs 4.00 [IQR 2.00, 7.00] days, p< 0.001). Patients with lmTBI (vs. hmTBI) were more likely to have intracranial pressure (30.3% vs. 3.1%) and intra-arterial blood pressure monitoring (51.5% vs. 27.9%) and a longer duration of ICU stay 5.00 [4.00, 9.74] vs 4.00 [2.00, 6.00]) days, (p < 0.05). At 3 months follow-up, GOS-E Peds scores were different in the 3 groups (hmTBI (1.00 [IQR 1.00, 3.00]), lm TBI (3.00 [IQR 2.00, 6.00]) and sTBI (5.00 [IQR 1.00, 6.25]), (p< 0.001). Conclusions: Patients with lmTBI have higher rates of neurocritical care utilization and worse functional outcomes than those with hmTBI but better than those with sTBI. Our findings highlight the importance of routinely considering multimodal neuromonitoring and ICP targeted treatments to improve outcomes in this population.