Base deficit correlates with mortality in pediatric abusive head trauma.

Journal of pediatric surgery

PubMedID: 24094965

Stewart CL, Holscher CM, Moore EE, Bronsert M, Moulton SL, Partrick DA, Bensard DD. Base deficit correlates with mortality in pediatric abusive head trauma. J Pediatr Surg. 2013;48(10):2106-11.
BACKGROUND/PURPOSE
Children suffering from abusive head trauma (AHT) have worse outcomes compared to non-AHT, but the reasons for this are unclear. We hypothesized that delayed medical care associated with AHT causes prolonged pre-hospital hypotension and hypoxia as measured by admission base deficit (BD), and that this would correlate with outcome.

METHODS
We performed a 10-year retrospective chart review of children admitted for AHT at two academic level-I trauma centers. Statistics were performed using Student's t test, chi-square analysis, and multivariate logistic regression, and considered significant at p<0.05.

RESULTS
Four-hundred twelve children with AHT were identified, and admission BD was drawn for 148/412 (36%) children, including 104 survivors and 44 non-survivors. Non-survivors had significantly higher BD compared to survivors (12.6±1.6 versus 5.3±0.6, p<0.001). Non-survivors were more likely to be intubated pre-hospital and get cardiopulmonary resuscitation (CPR) (p<0.001). Mortality increased with rising BD, according to CPR status. There was no difference in patterns of brain injury between survivors and non-survivors (p>0.05).

CONCLUSIONS
BD correlates with mortality in children suffering severe AHT. Non-survivors are also more likely to be intubated pre-hospital and require CPR, with no difference in pattern of brain injury, suggesting that secondary injury is a major determinant of outcome in severe AHT.