Hyperglycemia in pediatric head trauma patients: A cross-sectional study

Abstract

To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS).
A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia.
A total of 340 children were included and 60 (17.6%) had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans.
Hyperglycemia was more prevalent in patients with severe head trauma (GCS <8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.

Full text






José Roberto Tude Melo1, Rodolfo Casimiro Reis2, Laudenor Pereira Lemos-Júnior2,
Henrique Miguel Santos Coelho2, Carlos Eduardo Romeu de Almeida2, Jamary Oliveira-Filho3
  Objective: 
  Method: 


  Results: 


  Conclusion: 
≤



  Objetivo: 
  Método: 



  Resultados: 



  Conclusão: 
≤






Dr. José Roberto Tude Melo – Hospital Universitário Professor Edgard Santos/UFBA - Rua Augusto Viana sn / 2º andar - 40110-060 Salvador BA - Brasil.
E-mail: robertotude@gmail.com



























Study design and data collection






















Hyperglycemia






Ethical concerns and data analyses





χ




±











<

<





 


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1. Kuzuya T, Nakagawa S, Satoh J, et al. Report of the Committee on the
classication and diagnostic criteria of diabetes mellitus. Diabetes Res
Clin Pract 2002;55:65-85.
2. Tominaga M. [Diagnostic criteria for diabetes mellitus]. Rinsho Byori
1999;47:901-908.
3. Chiaretti A, De BR, Langer A, et al. Prognostic implications of hyperg-
lycaemia in paediatric head injury. Childs Nerv Syst 1998;14:455-459.
4. Chiaretti A, Piastra M, Pulitano S, et al. Prognostic factors and outcome
of children with severe head injury: an 8-year experience. Childs Nerv
Syst 2002;18:129-136.
5. Cochran A, Scaife ER, Hansen KW, Downey EC. Hyperglycemia and
outcomes from pediatric traumatic brain injury. J Trauma 2003;55:
1035-1038.
6. Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and neu-
rological outcome in patients with head injury. J Neurosurg 1991;75:
545-551.
7. Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Ad-
mission hyperglycemia is predictive of outcome in critically ill trauma
patients. J Trauma 2005;59:80-83.
8. Schelp AO, Burini RC. [Cerebral glucose metabolism in craniocerebral
trauma: an evaluation]. Arq Neuropsiquiatr 1995;53:698-705.
9. Yamaguchi N. Sympathoadrenal system in neuroendocrine control of
glucose: mechanisms involved in the liver, pancreas, and adrenal gland
under hemorrhagic and hypoglycemic stress. Can J Physiol Pharmacol
1992;70:167-206.
10. Parish RA, Webb KS. Hyperglycemia is not a poor prognostic sign in
head-injured children. J Trauma 1988;28:517-519.
11. World Health Organization. Child and adolescent health and develop-
ment. Available at (http:///www.who.int/en/) Accessed November
01, 2007.
12. Teasdale G, Jennett B. Assessment of coma and impaired consciousness.
A practical scale. Lancet 1974 13;7872;81-84.
13. Marcoux KK. Management of increased intracranial pressure in the
critically ill child with an acute neurological injury. AACN Clin Issues
2005;16:212-231.
14. Orliaguet GA, Meyer PG, Baugnon T. Management of critically ill chil-
dren with traumatic brain injury. Paediatr Anaesth 2008;18 :455-461.
15. Melo JR, Santana DL, Pereira JL, Ribeiro TF. [Traumatic brain injury in
children and adolescents at Salvador City, Bahia, Brazil]. Arq Neurop-
siquiatr 2006;64:994-996.
16. Melo JR, Silva RA, Moreira ED Jr. [Characteristics of patients with head in-
jury at Salvador City (Bahia--Brazil)]. Arq Neuropsiquiatr 2004;62;711-714.
17. Bochicchio GV, Sung J, Joshi M, et al. Persistent hyperglycemia is predic-
tive of outcome in critically ill trauma patients. J Trauma 2005;58;921-924.
18. Bochicchio GV, Joshi M, Bochicchio KM, et al. Early hyperglycemic
control is important in critically injured trauma patients. J Trauma
2007;63;1353-1358.
19. Epstein J, Breslow MJ. The stress response of critical illness. Crit Care
Clin 1999;15;17-33.
20. Hirsch IB. In-patient hyperglycemia--are we ready to treat it yet? J Clin
Endocrinol Metab 2002;87;975-977.
21. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hy-
perglycemia: an independent marker of in-hospital mortality in patients
with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87;978-982.
22. Parejo P, Stahl N, Xu W, Reinstrup P, Ungerstedt U, Nordstrom CH. Ce-
rebral energy metabolism during transient hyperglycemia in patients
with severe brain trauma. Intensive Care Med 2003;29;544-550.
23. Jeremitsky E, Omert LA, Dunham CM, Wilberger J, Rodriguez A. The
impact of hyperglycemia on patients with severe brain injury. J Trau-
ma 2005;58;47-50.
24. Laird AM, Miller PR, Kilgo PD, Meredith JW, Chang MC. Relation-
ship of early hyperglycemia to mortality in trauma patients. J Trauma
2004;56;1058-1062.
25. Durr JA, Hoffman WH, Sklar AH, el GT, Steinhart CM. Correlates of
brain edema in uncontrolled IDDM. Diabetes 1992;41;627-632.
26. Kushner M, Nencini P, Reivich M, et al. Relation of hyperglycemia ear-
ly in ischemic brain infarction to cerebral anatomy, metabolism, and
clinical outcome. Ann Neurol 1990;28: 129-135.