Factors Associated With 3-Month Neurological Outcome in Pediatric Patients With Traumatic Brain Injury: A Preliminary Study.

Background

Traumatic brain injury (TBI) is associated with significant morbidity and mortality in pediatric patients. We aimed to evaluate demographic, clinical, and intensive care unit (ICU)-related factors associated with neurological outcome assessed using the Glasgow Outcome Scale-Extended (GOSE) in pediatric patients with moderate to severe TBI.

Methods

Pediatric patients (18 y or younger) with moderate to severe TBI (Glasgow Coma Scale [GCS] ≤12) admitted in the neuro-ICU were enrolled (November 1, 2024, to November 30, 2025). The primary outcome was to evaluate the association of demographic, clinical, and ICU-related variables with functional outcome at 3 months. Multivariable logistic regression identified factors associated with neurological outcome; and P<0.05 was considered significant.

Results

A total of 82 patients were included (median [range] age of 5 [2 to 9] y; male:female ratio: 58:24). At 3 months, 61 patients had GOSE ≥5 and 18 had GOSE ≤4 (lost to follow-up: 3 patients). Patients with a favorable outcome (GOSE ≥5) had significantly higher admission GCS and GCS-Pupil (GCS-P) score, favorable pupillary reactivity, lower rates of intubation, bradycardia, hypotension, hyperglycemia, hyperlactatemia, coagulopathy, inotrope use, tracheostomy, and early enteral feeding. On multivariable analysis, admission GCS (OR: 0.33, 95% CI: 0.15-0.74; P=0.007), systolic blood pressure <20% from baseline (OR: 0.046, 95% CI: 0.004-0.49; P=0.011), and tracheostomy (OR: 0.085, 95% CI: 0.009-0.79; P=0.031) were independently associated with a favorable outcome.

Conclusion

Our preliminary data suggest that higher admission GCS, lower incidence of hypotension, and tracheostomy are associated with a favorable neurological outcome at 3 months in pediatric patients with moderate to severe TBI.