Authors: Rebekah Kimball; Stephanie Eyerly-Webb, PhD; Rachele Solomon, MPH; Elad Shachar; Dean Hertzler, MD; Heather Spader, MD (Longwood, FL)
neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker widely utilized in other specialties, to help predict outcomes in pediatric TBI.
A retrospective review of pediatric patients presenting to our institution with TBI from 2007 to 2017 was performed (n=188, age=0-18 years). Absolute neutrophil count and absolute lymphocyte count on admission and approximately twenty-four and forty-eight hours post-injury were used to calculate NLRs. Data points included GCS on admission, extended Glasgow Outcome Scale (GOS-E) score, and presence of post-traumatic amnesia and/or loss of consciousness. Patients were stratified based on GOS-E score: none to mild disability (GOS-E=1-2), moderate to severe disability (GOS-E=3-6), or vegetative state/death (GOS-E=7-8).
A one-way ANOVA demonstrated statistically significant differences in NLR among patients stratified by GOS-E at 24 hours [F(2,55)=6.26, p=0.004] and 48 hours [F(2,24)=7.59, p=0.003]. No significant differences in NLR or neutrophils were observed at any time point based on GCS category or post-traumatic amnesia. Patients who experienced loss of consciousness had a significantly higher NLR on admission (p=0.013) and at 24 hours (p=<0.001) compared to those who did not lose consciousness.
In this study, a higher NLR twenty-four hours post-TBI predicted worse outcomes in pediatric patients. There was no difference based upon admit NLR. This suggests that NLR may be a useful outcome predictor in pediatric TBI as well as a possible future target for therapeutic intervention. Further study is warranted with larger prospective trials, different time points, and alternative inflammation markers.