1327. Pre-hospital Hypocapnia, Hypoxia and Hypothermia Impacts Mortality in Pediatric Traumatic Brain Injury

Authors: Laurie Lynn Ackerman, MD, FAANS; Teresa Bell, PhD; Riad Lutfi, MD; Alison Baker, MD; Jodi Raymond; Alex Stout; Dillon Mobasser; Courtney Rowan, MD; Rachel Hardacker (Indianapolis, IN)

INTRODUCTION: Traumatic brain injury (TBI) is a leading cause of death and disability in pediatric trauma patients. There is limited data with regard to the incidence of hypocapnia, hypercapnia, hypoxia and hypothermia in TBI patients prior to arrival at tertiary/quaternary care centers. Further, little information exists with regard to these risk factors in the pre-hospital setting as predictive of mortality in pediatric TBI. The aim of this study was to identify pre-hospital setting risk factors associated with poor outcomes in pediatric TBI. METHODS: This is a retrospective cohort study of TBI patients, 18 years and younger, admitted to the PICU at a quaternary care pediatric trauma center from 2010 to 2017. Pre-hospital data (including scene, hospital transfer and interfacility transfer) were collected including pooled variables for hypocapnia ( 45 mmHg), hypoxemia (< 92% SaO2), hypothermia (< 36○C), seizures, and Glasgow Coma Sale (GCS) on arrival. We used chi square tests to determine if these were associated with mortality or inpatient rehabilitation stays. RESULTS: The study included 321 pediatric patients with TBI. Hospital mortality was 28%, and 32% of those who survived were admitted to inpatient rehabilitation. Excluding patients who were intubated and/or received neuromuscular blockade, 91.4% had a GCS of 8 or less, indicating severe head trauma. Seizures were observed in 7.8%. Several patients experienced hypocapnia (15.0%), hypercapnia (8.1%), hypoxemia (19.9%) and hypothermia (38.3%) in the pre-hospital setting. Non-survivors had a higher occurrence of hypoxemia (p<0.001), hypothermia (p<0.001) and hypocapnia (p=0.008). Hypocapnia, hypercapnia, hypoxemia, hypothermia and seizures were not predictive of being admitted to inpatient rehabilitation. CONCLUSION: Our study suggests hypocapnia, hypoxemia and hypothermia prior to admission, could play a role in mortality in pediatric TBI. Education initiatives focusing on monitoring carbon dioxide levels and avoiding hypoxemia and hypothermia in TBI patients in the pre-hospital setting could reduce mortality.