Temporal Patterns in Brain Tissue Oxygenation Associated With Mortality After Severe TBI in Children
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Neuroscience, Trauma, Pediatrics, 2022
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INTRODUCTION: Brain tissue hypoxia is an independent risk factor for unfavorable outcomes in traumatic brain injury (TBI). Current guidelines provide only a level III recommendation and target a time-independent partial pressure of oxygen in brain tissue (PbtO2) threshold of 10 mmHg in children with severe TBI. We aimed to determine if temporal patterns of PbtO2 were associated with mortality in severe pediatric TBI and to compute the PbtO2 cut-off value that optimally dichotomized mortality. METHODS: Ten years of data from (1/2009-4/2019) were extracted from the electronic medical record of a children's hospital with a level 1 trauma center for patients ≤18 years old with severe TBI and the presence of PbtO2 and/or intracranial pressure (ICP) monitors. Data were summarized with descriptive statistics and temporal analyses performed for the first 5 days of hospitalization. Multivariable logistic regression was used to evaluate the impact of different patient and clinical characteristics on in-hospital mortality. RESULTS: 138 ICP-monitored TBI patients (7.0±5.7y; 65% male; admission Glasgow Coma Scale [GCS] score 4 [3-7]; mortality 18%), 71 with and 67 without PbtO2 monitors were included. Time-series analyses showed lower PbtO2 values (days 1, 3-5) and lower PbtO2/PaO2 ratios (days 2, 5) in patients that died vs. survived. A PbtO2 of 30 mmHg and PbtO2/PaO2 of 0.12 were identified by Youden’s method when modeled with a mortality outcome. Patients with vs. without PbtO2 monitors had higher PaO2 values and those that died had evidence of relative hyperoxemia. Multivariable logistic regression identified older age, lower admission GCS score, PbtO2 < 30 mmHg, hyperoxemia (PaO2 ≥ 300 mm Hg), hypoxemia (PaO2 < 80 mmHg), and PbtO2/PaO2 ratio < 0.12 to be independently associated with mortality. CONCLUSIONS: We identified optimal cut-off values for PbtO2 threshold and PbtO2/PaO2 ratio to discriminate in-hospital mortality in severe TBI patients in our center. Our results corroborate our prior work that suggests targeting a higher PbtO2 threshold than recommended in the Guidelines, and the need to evaluate the potential utility of the PbtO2/PaO2 ratio to manage severe pediatric TBI. Further studies using proactively targeted PbtO2 values and PbtO2/PaO2 ratios for clinical decision-making in pediatric TBI are warranted.
Meta Tag
Content Type Presentation
Knowledge Area Neuroscience
Knowledge Area Trauma
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Traumatic Brain Injury TBI
Tag Pediatrics
Tag Burns
Tag Tissue Oxygenation
Year 2022
Pediatric traumatic brain injury
brain tissue oxygenation
cerebral perfusion pressure
arterial oxygen levels


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