Blood pressure is a predictor of mortality in pediatric traumatic brain injury

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In the United States, traumatic brain injury (TBI) accounts for nearly half of all deaths in children older than a year. More than 50,000 children in the United States are hospitalized for TBI each year, so researchers are working to prevent pediatric injury and to improve therapeutic strategies. However, significant gaps still exist in the current research on pediatric TBI.

Typically, clinicians who treat adult TBI monitor patients’ blood pressure as a predictor of injury-related mortality. Adults who exhibit hypotension (low blood pressure) and hypertension (high blood pressure) may be at higher risk for poor outcomes after severe TBI. For example, an episode of hypertension occurring soon after injury can lead to reduced blood flow to certain areas of the brain, resulting in increased morbidity and mortality. However, the association between blood pressure and TBI outcomes in children has been insufficiently studied.

As a result, a group of researchers in the United States recently investigated the relationship between systemic blood pressure and pediatric TBI. They gathered 4,990 patient records from the Department of Defense Trauma Registry, including only children under 18 years of age with severe TBI. They found that:

  • More than 40% of patients had moderate or severe hypertension, while only 6.8% had hypotension.
  • Patients with hypertension were more likely to have more severe injury scores and were more likely to undergo surgery as a result of their injuries.
  • Hypertension was associated with increased 24-hour mortality, while hypotension and normal blood pressure were not associated with mortality.

Much like adults, children with TBI are at higher risk for mortality and negative outcomes when they present to the emergency department with hypertension. Blood pressure is a valuable tool for predicting early mortality risk, and the relationship between blood pressure and pediatric injury merits further study to improve outcomes in children who sustain TBI.

Johnson MA, Borgman MA, Cannon JW, et al. Severely elevated blood pressure and early mortality in children with traumatic brain injuries: The neglected end of the spectrum. Western Journal of Emergency Medicine. (May 2018).

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