Hyperglycemia: an independent risk factor for poor outcome in children with traumatic brain injury*.

Abstract

We sought 1) to describe the severity and duration of hyperglycemia among surviving and dying children after traumatic brain injury; 2) to evaluate whether persistent severe hyperglycemia (averaged blood glucose > 200 mg/dL [11 mmol/L] during the first 12 hr after injury) is independently associated with poor Glasgow Outcome Score; and 3) to evaluate different definitions and the prevalence of poor Glasgow Outcome Score to better understand measurement and potential hyperglycemia treatment evaluation. Retrospective cohort. Level I American College of Surgery verified pediatric trauma center. Children admitted to intensive care with moderate-to-severe traumatic brain injury. None. Time course for glucose changes was compared by survival and blood glucose groups. Twelve-hour averaged patient blood glucoses were categorized as persistent: severe hyperglycemia (> 200 mg/dL [11 mmol/L]), moderate hyperglycemia (161-200 mg/dL [9-11 mmol/L]), mild hyperglycemia (110-160 mg/dL [6-9 mmol/L]), normal glycemia (80-109 mg/dL [4-6 mmol/L]), or hypoglycemia (< 80 mg/dL [< 4 mmol/L]). Among 271 children, less than 1% had hypoglycemia and were excluded from further analysis. Seven percent had normal, 49% had mild, 24% had moderate, and 20% had severe blood glucose elevation. Among dying children (n = 44, 16%), the mean blood glucose at 20-24 hours after injury was significantly greater compared with survivors (150 vs 113 mg/dL [8 vs 6 mmol/L]) but by 29-32 hours, no longer significantly differed (112 vs 102 mg/dL [6 mmol/L]). Sixty-eight percent of children with severe blood glucose elevation had a poor outcome, whereas good outcomes at discharge occurred in 87% with mild or moderate blood glucose elevation. Severe blood glucose elevation was associated with a 3.5-fold increased adjusted odds ratio of poor outcome (95% CI, 1.2-10.3) compared with mild blood glucose elevation adjusted for injury severity and cardiorespiratory instability. Duration of severe blood glucose elevation (blood glucose > 200 mg/dL [11 mmol/L]) was brief but remained independently associated with poor outcome.