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{
    "pk": 11329,
    "title": "Severely Elevated Blood Pressure and Early Mortality in Children with Traumatic Brain Injuries: The Neglected End of the Spectrum",
    "subtitle": null,
    "abstract": "Introduction:\n In adults with traumatic brain injuries (TBI), hypotension and hypertension at presentation are associated with mortality. The effect of age-adjusted blood pressure in children with TBI has been insufficiently studied. We sought to determine if age-adjusted hypertension in children with severe TBI is associated with mortality.\nMethods:\n This was a retrospective analysis of the Department of Defense Trauma Registry (DoDTR) between 2001 and 2013. We included for analysis patients <18 years with severe TBI defined as Abbreviated Injury Severity (AIS) scores of the head ≥3. We defined hypertension  as moderate for systolic blood pressures (SBP) between the 95th and 99th percentile for age and gender and severe if greater than the 99th percentile. Hypotension was defined as SBP <90 mmHg for children >10 years or < 70mmHg + (2 x age) for children ≤10 years. We performed multivariable logistic regression and Cox regression to determine if BP categories were associated with mortality. \nResults:\n Of 4,990 children included in the DoDTR, 740 met criteria for analysis. Fifty patients (6.8%) were hypotensive upon arrival to the ED, 385 (52.0%) were normotensive, 115 (15.5%) had moderate hypertension, and 190 (25.7%) had severe hypertension. When compared to normotensive patients, moderate and severe hypertension patients had similar Injury Severity Scores, similar AIS head scores, and similar frequencies of neurosurgical procedures. Multivariable logistic regression demonstrated that hypotension (odd ratio [OR] 2.85, 95 confidence interval [CI] 1.26-6.47) and severe hypertension (OR 2.58, 95 CI 1.32-5.03) were associated with increased 24-hour mortality. Neither hypotension (Hazard ratio (HR) 1.52, 95 CI 0.74-3.11) nor severe hypertension (HR 1.65, 95 CI 0.65-2.30) was associated with time to mortality. \nConclusion:\n Pediatric, age-adjusted hypertension is frequent after severe TBI. Severe hypertension is strongly associated with 24-hour mortality. Pediatric, age-adjusted blood pressure needs to be further evaluated as a critical marker of early mortality.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "pediatrics, trauma, traumatic brain injury, hypertension"
        }
    ],
    "section": "Critical Care",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3pw236v6",
    "frozenauthors": [
        {
            "first_name": "M.",
            "middle_name": "Austin",
            "last_name": "Johnson",
            "name_suffix": "",
            "institution": "University of California Davis Medical Center, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Matthew",
            "middle_name": "A.",
            "last_name": "Borgman",
            "name_suffix": "",
            "institution": "San Antonio Military Medical Center, Department of Pediatrics, Houston, Texas\nUniformed Services University of the Health Sciences, Department of Pediatrics, Bethesda, Maryland",
            "department": "None"
        },
        {
            "first_name": "Jeremy",
            "middle_name": "W.",
            "last_name": "Cannon",
            "name_suffix": "",
            "institution": "Perelman School of Medicine at the University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Nathan",
            "middle_name": "",
            "last_name": "Kuppermann",
            "name_suffix": "",
            "institution": "University of California Davis Medical Center, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Lucas",
            "middle_name": "P.",
            "last_name": "Neff",
            "name_suffix": "",
            "institution": "David Grant USAF Medical Center, Travis Air Force Base, Department of General Surgery, Fairfield, California\nUniversity of California Davis Medical Center, Department of Surgery, Sacramento, California\nUniformed Services University of the Health Sciences, Department of Surgery, Bethesda, Maryland",
            "department": "None"
        }
    ],
    "date_submitted": "2017-09-15T17:56:21Z",
    "date_accepted": "2017-09-15T17:56:21Z",
    "date_published": "2018-04-05T19:00:38Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11329/galley/6148/download/"
        }
    ]
}