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Are Age-Specific Thresholds for Cerebral Perfusion Pressure Associated with Outcomes in Pediatric Traumatic Brain Injury?

Pediatric traumatic brain injury (TBI) remains the leading cause of mortality in children younger than 19 years. Most people think that the secondary brain injury following TBI occurs in the setting of elevated intracranial pressure (ICP) and diminished cerebral perfusion pressure (CPP). These physiologic measurements are thought to affect outcomes, so current guidelines recommend treatment of both elevated ICPs and decreased CPPs, although the thresholds for CPPs have not been well established in children. Although a smaller study looked at CPP in children with TBI, this work by Allen et al is the largest study to date that attempts to determine these thresholds.

Using a prospective, observational cohort, the authors examined data from TBI-trac, an online data repository run by the Brain Trauma Foundation. This databank collects information about patients with severe TBI and uses these data to track guideline compliance at 22 different trauma centers and for research. In this report, the authors reviewed the data on patients treated between 2000 and 2008.

In all, the authors studied 2074 records and divided the patients into categories based on age: 0-5 years (55 patients), 6-11 years (65 patients), 12-17 years (197 patients), and 18 years or older (1757 patients). They subsequently defined high and low CPP thresholds for each age group to determine if these thresholds impacted short-term survival. For those in the youngest group, the authors chose 30 mm Hg for a low CPP threshold (CPP-L) and 40 mm Hg for a high threshold (CPP-H). For subjects in the group 6-11 years, the CPP-L was 35 mm Hg and the CPP-H was 50 mm Hg. For the subjects 12 years or older, the CPP-L selected was 50 mm Hg and the CPP-H was 60 mm Hg. CPP values between the high and low thresholds were labeled as CPP-B.

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