Cushing's sign and severe traumatic brain injury in children after blunt trauma: A nationwide retrospective cohort study in Japan

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Abstract

Objective We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. Design Retrospective cohort study using Japan Trauma Data Bank. Setting Emergency and critical care centres in secondary and tertiary hospitals in Japan. Participants Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. Primary outcome measures Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. Results In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. Conclusions Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-Age children and young adolescents.

Original languageEnglish
Article numbere020781
JournalBMJ Open
Volume8
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Japan
Cohort Studies
Retrospective Studies
Blood Pressure
Wounds and Injuries
Heart Rate
Logistic Models
Hypertension
Glasgow Coma Scale
Vital Signs
Emergency Medical Services
Critical Care
Bradycardia
Tertiary Care Centers
Shock
Outcome Assessment (Health Care)
Traumatic Brain Injury
Databases
Pediatrics
Hemorrhage

Keywords

  • paediatric neurology
  • paediatric neurosurgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{4a332fc9bb434ac5909ad533f95b33e8,
title = "Cushing's sign and severe traumatic brain injury in children after blunt trauma: A nationwide retrospective cohort study in Japan",
abstract = "Objective We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. Design Retrospective cohort study using Japan Trauma Data Bank. Setting Emergency and critical care centres in secondary and tertiary hospitals in Japan. Participants Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. Primary outcome measures Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. Results In the study cohort, 297 (20.1{\%}) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95{\%} CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. Conclusions Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-Age children and young adolescents.",
keywords = "paediatric neurology, paediatric neurosurgery",
author = "Tetsuya Yumoto and Hiromichi Naito and Takashi Yorifuji and Hiroki Maeyama and Yoshinori Kosaki and Hirotsugu Yamamoto and Kohei Tsukahara and Takaaki Osako and Atsunori Nakao",
year = "2018",
month = "3",
day = "1",
doi = "10.1136/bmjopen-2017-020781",
language = "English",
volume = "8",
journal = "BMJ Open",
issn = "2044-6055",
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TY - JOUR

T1 - Cushing's sign and severe traumatic brain injury in children after blunt trauma

T2 - A nationwide retrospective cohort study in Japan

AU - Yumoto, Tetsuya

AU - Naito, Hiromichi

AU - Yorifuji, Takashi

AU - Maeyama, Hiroki

AU - Kosaki, Yoshinori

AU - Yamamoto, Hirotsugu

AU - Tsukahara, Kohei

AU - Osako, Takaaki

AU - Nakao, Atsunori

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objective We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. Design Retrospective cohort study using Japan Trauma Data Bank. Setting Emergency and critical care centres in secondary and tertiary hospitals in Japan. Participants Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. Primary outcome measures Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. Results In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. Conclusions Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-Age children and young adolescents.

AB - Objective We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. Design Retrospective cohort study using Japan Trauma Data Bank. Setting Emergency and critical care centres in secondary and tertiary hospitals in Japan. Participants Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. Primary outcome measures Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. Results In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. Conclusions Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-Age children and young adolescents.

KW - paediatric neurology

KW - paediatric neurosurgery

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U2 - 10.1136/bmjopen-2017-020781

DO - 10.1136/bmjopen-2017-020781

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AN - SCOPUS:85043302181

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 3

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