Admission base deficit as a long-term prognostic factor in severe pediatric trauma patients.
ABSTRACT Base deficit (BD) is a prognostic tool that correlates with trauma scores and mortality in adult trauma patients. Retrospective studies have shown that admission BD more than 8 mmol/L is associated with an increased risk of mortality. This is the first prospective European study aimed at evaluating the prognostic value of admission BD in traumatized children.
One hundred severely traumatized children were included if an arterial BD had been calculated on arrival in the trauma room of a university hospital. Epidemiologic, medical, and biological data (including admission BD and lactates concentration) were recorded and compared using a univariate analysis. The primary endpoint was in-hospital mortality. Secondary endpoints were outcome on discharge and at 6 months. Cutoff values for BD or lactates regarding outcomes were determined using receiver operating characteristic curves if these data had been isolated on multivariate analysis (p < 0.05).
Sixty-eight boys and 32 girls, aged 6.7 years, were enrolled from March 2003 to December 2005, mainly after road traffic accidents. Twenty-two died at the hospital, 34 children and 51 children were classified as having a good outcome on hospital discharge and 6 months later, respectively. After the multivariate procedure and receiver operating characteristic curve analysis, admission lactates more than 2.94 mmol/L and admission BD more than 5 mEq/L were independent risk factors for mortality (odds ratio 2.4 [95% confidence interval 1.3-4.6]) and poor outcome at 6 months (odds ratio 2.5 [95% confidence interval 1.13-5.5]), respectively.
BD could be used to predict the long-term morbidity and may not be related to morbidity and mortality at discharge.
- SourceAvailable from: Stephane Blanot[show abstract] [hide abstract]
ABSTRACT: To describe the results of an integrated pre- and in-hospital approach to critical care in a large population of children with severe traumatic brain injury and to identify the early predictors of their outcome. A 9-yr retrospective review of the data of a trauma data bank. Level III pediatric trauma center. All children (1 month to 15 yrs) with severe traumatic brain injury (Glasgow Coma Scale </=8) hospitalized in our trauma center and followed until death or for >/=6 months after discharge. None. Univariate and further multivariate analyses were performed to determine independent predictive factors of death and outcome at discharge and 6 months later. The Glasgow Outcome Scale was used to evaluate outcome; a poor outcome referred to Glasgow Outcome Scale >/=3. Receiver operating characteristic curves were drawn to determine the threshold values of predictors of death and outcome. Analysis concerned 585 children (67% male and 33% female). Mean age was 7 +/- 5 yrs. Predominant mechanisms of injury were road traffic accidents and falls. Mean values for Glasgow Coma Scale, Pediatric Trauma Score, and Injury Severity Score were 6 (3-8), 3 (-4,10), and 28 (4-75), respectively. Mortality rate was 22%; Glasgow Outcome Scale was <3 in 53% of the cases at discharge and 60% at 6 months. Multivariate analysis identified Glasgow Coma Scale, Injury Severity Score, and hypotension on arrival as independent predictors of death and poor outcome at discharge and at 6 months. Threshold values for death were 28 for Injury Severity Score and 5 for Glasgow Coma Scale. The same values were found for poor outcome, except for outcome at 6 months where threshold value for the Glasgow Coma Scale was 6. Initial hypotension, Glasgow Coma Scale, and Injury Severity Score are independent predictors of outcome in children with traumatic brain injury. Threshold values can be calculated for predicting poor outcome. These variables can be easily and detected early in this population and used for quality assessment.Pediatric Critical Care Medicine 09/2006; 7(5):461-7. · 2.35 Impact Factor
Article: Two cases of allergy to leucovorin[show abstract] [hide abstract]
ABSTRACT: We report two cases of an immediate allergic reaction to leucovorin (folinic acid) with positive skin tests. One patient underwent oral desensitization and was then able to continue complete treatment for a metastatic colon cancer.Revue Francaise D Allergologie Et D Immunologie Clinique - REV FR ALLER IMMUNOL CLIN. 01/2003; 43(5):342-343.
- [show abstract] [hide abstract]
ABSTRACT: To assess outcomes 1 year after severe traumatic brain injury (TBI) among young children and to compare outcomes between children with inflicted versus noninflicted injuries. Prospective cohort study. All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state's 9 PICUs and who survived a severe TBI that occurred on or before their second birthday were eligible to participate. Child health status, child use of ancillary medical resources, and family characteristics were determined through maternal caregiver interviews approximately 1 year after injury. Comparisons were made between family characteristics and child outcomes according to injury type. Seventy-two interviews of maternal caregivers were completed among 112 survivors (64.3%). Children with inflicted injuries (n = 41) had worse outcomes than did children with noninflicted injuries (n = 31), as measured with the Pediatric Outcome Performance Category and Stein-Jessup Functional Status II (Revised) tools. However, approximately 50% of children with inflicted injuries had only mild deficits or better. Children with inflicted injuries had a higher use of ancillary medical resources. Families caring for the children did not differ substantively, with a large proportion of single, working, minority mothers. Children with inflicted TBIs had worse outcomes than did children with other TBIs 1 year after injury. However, outcomes for these children were better than those reported previously. Many families caring for children after severe TBI are socially disadvantaged. Interventions to improve child outcomes may include enhanced family support.PEDIATRICS 03/2006; 117(2):317-24. · 4.47 Impact Factor