Objective: The international scope of critical neurologic insults in children is unknown. Our objective was to assess the prevalence and outcomes of children admitted to PICUs with acute neurologic insults.
Design: Prospective study.
Setting: Multicenter (n = 107 PICUs) and multinational (23 countries, 79% in North America and Europe).
Patients: Children 7 days to 17 years old admitted to the ICU with new traumatic brain injury, stroke, cardiac arrest, CNS infection or inflammation, status epilepticus, spinal cord injury, hydrocephalus, or brain mass.
Measurements and Main Results: We evaluated the prevalence and outcomes of children with predetermined acute neurologic insults. Child and center characteristics were recorded. Unfavorable outcome was defined as change in pre-post insult Pediatric Cerebral Performance Category score greater than or equal to 2 or death at hospital discharge or 3 months, whichever came first. Screening data yielded overall prevalence of 16.2%. Of 924 children with acute neurologic insults, cardiac arrest (23%) and traumatic brain injury (19%) were the most common. All-cause mortality at hospital discharge was 12%. Cardiac arrest subjects had highest mortality (24%), and traumatic brain injury subjects had the most unfavorable outcomes (49%). The most common neurologic insult was infection/inflammation in South America, Asia, and the single African site but cardiac arrest in the remaining regions.
Conclusions: Neurologic insults are a significant pediatric international health issue. They are frequent and contribute substantial morbidity and mortality. These data suggest a need for an increased focus on acute critical neurologic diseases in infants and children including additional research, enhanced availability of clinical resources, and the development of new therapies.
1Division of Pediatric Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA.
2Department of Critical Care Medicine, Safar Center for Resuscitation Research, Pittsburgh, PA.
3Department of Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
4Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA.
5Departments of Neurology and Anaesthesia (Pediatrics), Harvard Medical School and Boston Children’s Hospital, Boston, MA.
6Division of Pediatric Intensive Care, Starship Children’s Hospital, Auckland, New Zealand.
7Departments of Critical Care and Paediatrics, Hospital for Sick Children, Toronto, ON, Canada.
8Injury Prevention and Research Center and Harborview Medical Center at the University of Washington, Seattle, WA.
9Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
10Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
11Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA.
*See also p. 385.
The PANGEA Investigators are listed in Appendix 1.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).
Supported, in part, by Laerdal Foundation and Department of Critical Care Medicine (University of Pittsburgh Medical Center).
Dr. Fink’s institution received funding from Laerdal Foundation, National Institutes of Health (NIH), and Patient Centered Outcomes Research Institute. She received funding from the Department of Critical Care Medicine (University of Pittsburgh Medical Center). Dr. Kochanek received funding from Society of Critical Care Medicine (SCCM; stipend for serving as the Editor-in-Chief of Pediatric Critical Care Medicine), serving as an expert witness on several cases over the past 36 months, and has received honoraria from numerous lectures at national meetings and/or as a guest professor at various institutions of higher education. He has also received stipends for editing/authoring books and/or chapters. Dr. Hutchison’s institution received funding from Canadian Institutes of Health Research, NIH, and Ontario Neurotrauma Foundation. Dr. Watson’s institution received funding from NIH (grant unrelated to the article). He has received funding from SCCM (board review course honorarium and travel), Centers for Disease Control and Prevention (CDC; travel to CDC workshop), and NIH (honorarium for grant review). The remaining authors have disclosed that they do not have any potential conflicts of interest.
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