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

Talia D Baird; Michael R Miller; Saoirse Cameron; Douglas D Fraser; Janice A Tijssen

doi:10.3389/fped.2021.793008

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

Front Pediatr. 2021 Dec 13:9:793008. doi: 10.3389/fped.2021.793008. eCollection 2021.

Authors

Talia D Baird¹, Michael R Miller^{2

3}, Saoirse Cameron^{2

3}, Douglas D Fraser^{2

3

4}, Janice A Tijssen^{2

3

5}

Affiliations

¹ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
² Department of Paediatrics, Western University, London, ON, Canada.
³ Children's Health Research Institute, London, ON, Canada.
⁴ Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
⁵ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.

Abstract

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. Methods: 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. Results: 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). Conclusions: 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.

Keywords: brain injury; critical care; pediatric; prognosis; trauma.