Repositorio Digital

Intensive care treatments associated with favorable discharge outcomes in Argentine children with severe traumatic brain injury: For the South American Guideline Adherence Group.

Mostrar el registro sencillo del ítem Vavilala, Mónica Luján, Silvia Qiu, Qian Bell, Michael Ballarini, Nicolás Guadagnoli, Nahuel Depetris, María Alejandra Faguaga, Gabriela Baggio, Gloria Busso, Leonardo García, Mirta Gónzalez Carrillo, Osvaldo Medici, Paula Sáenz, Silvia Vanella, Elida Farr, Carly Petroni, Gustavo 2018-04-17T19:06:17Z 2018-04-17T19:06:17Z 2017-12-15
dc.identifier.other 10.1371/journal.pone.0189296
dc.description Fil: Busso, L. Hospital de Alta Complejidad en Red El Cruce Dr. Néstor C. Kirchner. Florencio Varela, Argentina. es_AR
dc.description.abstract OBJECTIVE: Little is known about the critical care management of children with traumatic brain injury (TBI) in low middle income countries. We aimed to identify indicators of intensive care unit (ICU) treatments associated with favorable outcomes in Argentine children with severe TBI. METHODS: We conducted a secondary analysis of data from patients previously enrolled in a prospective seven center study of children with severe TBI who were admitted to an ICU in one of the seven study centers. Severe TBI was defined by head AIS ≥ 3, head CT with traumatic lesion, and admission GCS < 9. Seven indicators of best practice TBI care were examined. The primary outcome was discharge Pediatric Cerebral Performance Category Scale [PCPC] and Pediatric Overall Performance category Scale [POPC]. We also examined variation in ICU care and in-patient mortality. RESULTS: Of the 117 children, 67% were male and 7.5 (4.3) years on average, 92% had isolated TBI. Hypotension (54%) was more common than hypoxia (28%) and clinical or radiographic signs of high intracranial pressure (ICP) were observed in 92%. Yet, ICP monitoring occurred in 60% and hyperosmolar therapy was used in only 36%. Adherence to indicators of best TBI practice ranged from 55.6% to 83.7% across the seven centers and adherence was associated with favorable discharge PCPC (aRR 0.98; 95% CI [0.96, 0.99]), and POPC (aRR 0.98; 95% CI [0.96, 0.99]). Compared to patients whose adherence rates were below 65%, patients whose adherence rates were higher between 75%-100% had better discharge PCPC (aRR 0.28; 95% CI [0.10, 0.83]) and POPC (aRR 0.32; 95% CI [0.15, 0.73]. Two indicators were associated with favorable discharge PCPC: Avoidance of hypoxia (aRR 0.46; 95% CI [0.23, 0.93]), and Nutrition started in 72 hours (aRR 0.45; 95% CI [0.21, 0.99]). Avoiding hypoxia was also associated with favorable discharge POPC (aRR 0.47; 95% CI [0.22, 0.99]). CONCLUSION: There is variation in Argentine ICU practice in the care of children with severe TBI. Second insults are common and hyperosmolar therapy use is uncommon. Adherence to best practice TBI care by avoiding hypoxia and providing timely nutrition were associated with significantly favorable discharge outcomes. Implementing strategies that prevent hypoxia and facilitate early nutrition in the ICUs are urgently needed to improve pediatric TBI outcomes. es_AR
dc.language.iso en es_AR
dc.publisher PlosOne es_AR
dc.relation.ispartofseries PLoS ONE;12(12): e0189296
dc.subject Argentina es_AR
dc.subject Brain Injuries es_AR
dc.subject Lesiones Encefálicas es_AR
dc.subject Child es_AR
dc.subject Niño es_AR
dc.subject Critical Care es_AR
dc.subject Cuidados Críticos es_AR
dc.subject Patient Discharge es_AR
dc.subject Alta del Paciente es_AR
dc.subject Multicenter Study es_AR
dc.subject Estudio Multicéntrico es_AR
dc.subject Treatment Outcome es_AR
dc.subject Resultado del Tratamiento es_AR
dc.title Intensive care treatments associated with favorable discharge outcomes in Argentine children with severe traumatic brain injury: For the South American Guideline Adherence Group. es_AR
dc.type Article es_AR

Ficheros en el ítem

Este ítem aparece en la(s) siguiente(s) colección(ones)

Mostrar el registro sencillo del ítem