The association between lowest age-specific mean arterial pressure during the first four hours after pediatric intensive care unit admission and poor discharge outcome in pediatric traumatic brain injury

Abstract

The relation between mean arterial pressure and discharge outcome in children after severe traumatic brain injury is unclear. We assessed the prognosis of children with this condition in relation to the minimum age-specific mean arterial pressure percentile (ASMAPP) during the first four hours of intensive care unit admission. We examined the association between ASMAPP and discharge outcome in 168 pediatric patients admitted to the PICU with a Glasgow Coma Scale score < 9 who survived the first four hours of PICU admission. Poor discharge outcome was defined as in-hospital death, or discharge to an outside acute care facility or skilled nursing facility. Results were adjusted for non-head injury severity (maximum non-head abbreviated injury score (AIS) > 3), head injury severity (head AIS > 3), and vasoactive medication use within four hours of PICU admission. Data from 168 children with severe TBI were examined. Among children whose minimum ASMAPP exceeded the 4th percentile, the likelihood of an unfavorable outcome differed little across ASMAPP categories. In contrast, the proportions of patients with poor outcome (72%) or in-hospital death (67%) were high among those with minimum ASMAPP < 5th percentile. Compared to individuals with minimum ASMAPP > 75th percentile, those with a minimum ASMAPP < 5th percentile had a 60% increase in risk of a poor discharge outcome (95% confidence interval 0.8,3.2) and 3.8-fold increase in the risk of in-hospital death (95% confidence interval 1.3,11.4). ASMAPP < 5th percentile within the first four hours of PICU admission for severe traumatic brain injury was strongly associated with in-hospital mortality.