TY - JOUR
T1 - Traumatic brain injury and infectious encephalopathy in children from four resource-limited settings in Africa
AU - Fink, Ericka L.
AU - von Saint Andre‐von Arnim, Amelie
AU - Kumar, Rashmi
AU - Wilson, Patrick T.
AU - Bacha, Tigist
AU - Aklilu, Abenezer Tirsit
AU - Teklemariam, Tsegazeab Laeke
AU - Hooli, Shubhada
AU - Tuyisenge, Lisine
AU - Otupiri, Easmon
AU - Fabio, Anthony
AU - Gianakas, John
AU - Kochanek, Patrick M.
AU - Angus, Derek C.
AU - Tasker, Robert C.
AU - Cheifetz, Ira
AU - Thomas, Neal
AU - Thompson, Ann
AU - Curley, Martha A.Q.
AU - Jouvet, Philippe
AU - Markovitz, Barry
AU - Nishisaki, Akira
AU - Tucci, Marissa
AU - Watson, Scott
AU - Willson, Doug
N1 - Funding Information:
Drs. Fink’s, Bacha’s, and Kochanek’s institutions received funding from the Laerdal Foundation. Dr. Kumar received support for article research from a Laerdal grant. Dr. Wilson’s institution received funding from the University of Pittsburgh. Dr. Kochanek disclosed that he holds several patents/provisional patents in the field of acute brain injury, and his research is funded by the National Institutes of Health and the U.S. Department of Defense (although this study was not supported by those grants nor are the patents relevant to the current study); he received funding from the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies as Editor-in-Chief of Pediatric Critical Care Medicine; and he has served as an expert witness on a number of cases in the field of neurocritical care and resuscitation. The remaining authors have disclosed that they do not have any potential conflicts of interest. We thank Eric Yablonsky for his work on data quality and organization. The investigators appreciated the nonfinancial support of the following groups committed to the provision of excellent clinical care and research: Pediatric Acute Lung Injury and Sepsis Investigators, World Federation of Pediatric Intensive and Critical Care, and Pediatric Neurocritical Care Research Group. We are grateful to the patients, families, research staff, nurses, and physicians of all centers in this study for their generous efforts to help improve the outcomes of children with traumatic brain injury and infectious encephalopathy in low-resource setting.
Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2018/7
Y1 - 2018/7
N2 - Objectives: To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings. Design: Prospective study. Setting: Four hospitals in Sub-Saharan Africa. Patients: Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy. Interventions: None. Measurements and Main Results: We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy. Pediatric Cerebral Performance Category score was assessed pre morbidity and at hospital discharge. Overall, 130 children were studied (58 [45%] had traumatic brain injury) from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7). Forty-six percent had no prehospital care, and 64% required interhospital transport over 18 km (1–521 km). On comparing traumatic brain injury with infectious encephalopathy, there was no difference in presentation with altered mental state (80% vs 82%), but a greater proportion of traumatic brain injury cases had loss of consciousness (80% vs 53%; p = 0.004). Traumatic brain injury patients were older (median [range], 120 mo [6–204 mo] vs 13 mo [0.3–204 mo]), p value of less than 0.001, and more likely male (73% vs 51%), p value of less than 0.01. In 78% of infectious encephalopathy cases, cause was unknown. More infectious encephalopathy cases had a seizure (69% vs 12%; p < 0.001). In regard to outcome, infectious encephalopathy versus traumatic brain injury: hospital lengths of stay were longer for infectious encephalopathy (8 d [2–30 d] vs 4 d [1–36 d]; p = 0.003), discharge rate to home, or for inpatient rehabilitation, or death differed between infectious encephalopathy (85%, 1%, and 13%) and traumatic brain injury (79%, 12%, and 1%), respectively, p value equals to 0.044. There was no difference in the proportion of children surviving with normal or mild disability (73% traumatic brain injury vs 79% infectious encephalopathy; p = 0.526). Conclusions: The epidemiology and outcomes of pediatric traumatic brain injury and infectious encephalopathy varied by center and disease. To improve outcomes of these conditions in low-resource setting, focus should be on neurocritical care protocols for pre-hospital, hospital, and rehabilitative care.
AB - Objectives: To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings. Design: Prospective study. Setting: Four hospitals in Sub-Saharan Africa. Patients: Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy. Interventions: None. Measurements and Main Results: We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy. Pediatric Cerebral Performance Category score was assessed pre morbidity and at hospital discharge. Overall, 130 children were studied (58 [45%] had traumatic brain injury) from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7). Forty-six percent had no prehospital care, and 64% required interhospital transport over 18 km (1–521 km). On comparing traumatic brain injury with infectious encephalopathy, there was no difference in presentation with altered mental state (80% vs 82%), but a greater proportion of traumatic brain injury cases had loss of consciousness (80% vs 53%; p = 0.004). Traumatic brain injury patients were older (median [range], 120 mo [6–204 mo] vs 13 mo [0.3–204 mo]), p value of less than 0.001, and more likely male (73% vs 51%), p value of less than 0.01. In 78% of infectious encephalopathy cases, cause was unknown. More infectious encephalopathy cases had a seizure (69% vs 12%; p < 0.001). In regard to outcome, infectious encephalopathy versus traumatic brain injury: hospital lengths of stay were longer for infectious encephalopathy (8 d [2–30 d] vs 4 d [1–36 d]; p = 0.003), discharge rate to home, or for inpatient rehabilitation, or death differed between infectious encephalopathy (85%, 1%, and 13%) and traumatic brain injury (79%, 12%, and 1%), respectively, p value equals to 0.044. There was no difference in the proportion of children surviving with normal or mild disability (73% traumatic brain injury vs 79% infectious encephalopathy; p = 0.526). Conclusions: The epidemiology and outcomes of pediatric traumatic brain injury and infectious encephalopathy varied by center and disease. To improve outcomes of these conditions in low-resource setting, focus should be on neurocritical care protocols for pre-hospital, hospital, and rehabilitative care.
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U2 - 10.1097/PCC.0000000000001554
DO - 10.1097/PCC.0000000000001554
M3 - Article
C2 - 29664874
AN - SCOPUS:85065983288
VL - 19
SP - 649
EP - 657
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 7
ER -