1. IN PEDIATRIC TBI IN THE EMERGENCY ROOM
HYPERGLYCEMIA VS
GLASGOW COMA SCALE
IN PEDIATRIC TBI IN THE EMERGENCY ROOM
Dr.Karthick Jayapal

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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, ?????????

8. 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 150mg/dl as hyperglycemia

9. 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%).

10. 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.

11. 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).

12. 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”

13. 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

14. 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

15. Parejo P, Stahl N, Xu W, Reinstrup P, Ungerstedt U, Nordstrom CH
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Orliaguet GA, Meyer PG, Baugnon T. Management of critically ill children with traumatic brain injury. Paediatr Anaesth 2008;18 :
Bochicchio GV, Joshi M, Bochicchio KM, et al. Early hyperglycemic control is important in critically injured trauma patients. J Trauma 2007;63;
Parish RA, Webb KS. Hyperglycemia is not a poor prognostic sign in head-injured children. J Trauma 1988;28: