EARLY HYPOTENSION WORSENS NEUROLOGICAL OUTCOME IN PEDIATRIC-PATIENTS WITH MODERATELY SEVERE HEAD TRAUMA

Purpose: The objective of this study was to determine the morbidity as sociated with hypotension in the resuscitative phase of pediatric head trauma. Methods: A retrospective review (1990 to 1995) was performed at a level-1 pediatric trauma facility. Inclusion criteria included a Glasgow coma score (GCS) of 6 to 8 and absence of penetrating trauma o r bleeding disorders. The GCS was assigned using a postresuscitation e xamination by a neurosurgeon. Hypotension was defined as a blood press ure reading of less than the fifth percentile for age that lasted long er than 5 minutes. Episodes were monitored from the onset of injury th rough the first 24 hours of hospitalization. Glasgow outcome scale (GO S) was assigned based on a 3-month follow-up evaluation. Analysis of v ariance (ANOVA) and contingency table analysis were performed on all g roups, and a P value of less than .05 was taken to represent statistic al significance. Results: Seventy-two patients met inclusion criteria. They had a mean GCS of 7.2 and a mean age of 6 years; 97% survived. E arly hypotension was associated with worse neurological outcome (GOS) and prolonged hospitalization. There was no significant correlation be tween GOS and age, gender, injury mechanism, associated injuries, or t ransport time. Conclusions: These data suggest that maintaining adequa te blood pressure during the early resuscitation of pediatric blunt he ad trauma patients may improve neurological outcome. Copyright (C) 199 8 by W.B. Saunders Company.