HYPERGLYCEMIA VS GLASGOW COMA SCALE IN PEDIATRIC TBI

HYPERGLYCEMIA VS GLASGOW COMA SCALE IN PEDIATRIC TBI IN THE EMERGENCY ROOM DR. KARTHICK JAYAPAL

• Prevalence of acute hyperglycemia vs Glasgow coma scale(GCS) in Pediatric Traumatic brain injury in the Emergency Room • A high blood glucose is common in actually ill neurological patients, even in non-diabetics.

§ Some authors believe that patients with -hyperglycemia general have a low GCS, -poor neurological prognosis based on GCS § It is well known that such acute hyperglycemia is a result of catecholamine effects. § Blood glucose level related to poor prognosis in children and adolescent with head trauma, which makes the comparison of different studies important. §

§ Some authors, disagree on the association of hyperglycemia and poor prognosis, particularly in children and adolescents. § As high blood glucose levels are transient and basically reflect a body response after injury. • In the patient study we aimed to verify the prevalence of acute hyperglycemia in according to the severity of head injury

• Hyperglycemia in Pediatric TBI with comparison of GCS, studies are less • The initial BG and GCS in the Emergency room, can be used as a tool to assess the severity of TBI

• We cannot say if the higher blood glucose levels are responsible for poorer outcomes in the present observation. • Hyperglycemia in the outcomes of children and adolescents with severe head trauma, not yet well defined

• Child with high blood glucose levels following Head trauma with GCS level >13 in ER, ? ? ? ? ? • Child with normal blood glucose level following Head trauma with GCS <8 in ER, ? ? ? ? ?

• A prospective cross-sectional study • Age, sex, MOI, classification of trauma (isolated head trauma or multiple trauma), GCS & BG level on admission and CCT • 0 to 14 years-old with head trauma presented in the emergency room • Severity of head trauma was accessed by GCS score on admission • We considered values above 150 mg/dl as hyperglycemia

• Categorical data were analyzed by using χ2 analyses and Pearson analysis. • An inverse relationship between admission glucose levels and GCS score was found, (r=0. 32; p=0. 01). • A total of 440 patients were eligible. • Mean age was 9. 8 yr; 73. 2% were male. • Most frequent were fall from a height (34. 1%) and vehicle-pedestrian accidents (18. 2%).

• GCS classification, 295 patients-mild head trauma GCS 13– 15 70 patients-moderate head trauma GCS 9– 12 74 patients-severe head trauma GCS 3– 8 • Blood glucose levels on admission, 65 patients had hyperglycemia • The prevalence of hyperglycemia increased proportionally to the head trauma severity.

• Among hyperglycemic patients, 83% had abnormal brain parenchymal findings. • Only 35. 6% of the normoglycemic patients had abnormal CCT 11% in mild head trauma, 35% in moderate head trauma (p<0. 01 when compared to mild head trauma) 54% in cases considered severe (p<0. 01 when compared to mild head trauma).

• Hyperglycemia is more frequently observed in severe head trauma/multiple trauma. • Metabolic response to injury - high blood glucose levels and neuronal injury. • Therefore, our data are in accordance with the results from other authors who correlate “the head trauma severity and the metabolic response to trauma, particularly higher blood glucose levels”

• Abnormal CCT findings was more frequent in hyperglycemic patients. • We cannot conclude if the higher blood glucose levels are responsible for poorer outcomes in the present observation. • The meaning of hyperglycemia in the outcomes of children and adolescents with severe head trauma will be analyzed in a future study

Hyperglycemia was more prevalent in severe head trauma (GCS ≤ 8), regardless of etiology of trauma, mode of injury or multiple trauma in children with abnormal findings on head computed tomography scans

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