Objective: To determine when physiological ICP, CPP and MAP data in 6-hour epochs after head injury predict outcome in children.
Design: A prospective study of children with diffuse or focal head injuries (who had physiologically monitored data downloaded at 1-minute time resolutions) had their mean values of validated data for CPP, ICP and MAP determined for each 6-hour epoch taken from injury time. Receiver Operator Characteristic (ROC) curve analyses were used to identify which epoch best predicted outcome.
Subjects: 99 severely head injured children, admitted to two regional Paediatric Intensive Care Units.
Outcome measures: Six-month outcome was assessed using a modified GOS score, which was dichotomised into poor outcome (GOS 1, 2, &3) or good recovery (GOS 4&5).
Results: The areas under the ROC curves were greatest in epochs (0.78), (0.80) and (0.59) for CPP, ICP and MAP respectively. The different predictive epochs were not explained by the diffuse or focal nature of the head injury. The predictive epoch changed for different childhood age groups (2-6, 7-and 11-years.
Conclusions: Outcome from childhood head injury may be accurately predicted by the mean 6-hour ICP data on day 1, or the mean CPP data on day 4 post injury.
Jones PA, Chambers IR, Lo TYM, et al. Do the mean values of ICP, CPP and MAP (calculated from successive 6-hour epochs of real-time data) predict outcome at a critical time after TBI in children? Proceedings of the 146th Meeting of the Society of British Neurological Surgeons. British Journal of Neurosurgery 2005; 19(3): 268-287.
Dr. Iain R. Chambers, Cleveland Unit, Middlesbrough. Tel: +44 (0)1642-854-778.
Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, UK.
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