Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI

Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI

Baird TD; Miller MR; Cameron S; Fraser DD; Tijssen JA

Frontiers in Pediatrics

2021

Clinical factors; Death; Pediatrics; Physiologic factors; Traumatic brain injury

Aims and Objectives: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Our aim was to determine the mode of death for children who died with sTBI in a Pediatric Critical Care Unit (PCCU) and evaluate factors associated with mortality. Method(s): We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score >= 12) with sTBI (Glasgow Coma Scale [GCS] <= 8 and Maximum Abbreviated Injury Scale >= 4) admitted to a Canadian PCCU (2000-2016). We analyzed mode of death, clinical factors, interventions, lab values within 24 h of admission (early) and pre-death (48 h prior to death), and reviewed meeting notes in patients who died in the PCCU. Result(s): Of 195 included patients with sTBI, 55 (28%) died in the PCCU. Of these, 31 (56%) had a physiologic death (neurologic determination of death or cardiac arrest), while 24 (44%) had withdrawal of life-sustaining therapies (WLST). Median (IQR) times to death were 35.2 (11.8, 86.4) hours in the physiologic group and 79.5 (17.6, 231.3) hours in the WLST group (p = 0.08). The physiologic group had higher partial thromboplastin time (PTT) within 24 h of admission (p = 0.04) and lower albumin prior to death (p = 0.04). Conclusion(s): Almost half of sTBI deaths in the PCCU were by WLST. There was a trend toward a longer time to death in these patients. We found few early and late (pre-death) factors associated with mode of death, namely higher PTT and lower albumin. Copyright © 2021 Baird, Miller, Cameron, Fraser and Tijssen.

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