Early Continuous Electroencephalography, Clinical Parameters, and Short-Term Functional Outcomes in Pediatric Traumatic Brain Injury: Single-Center, Retrospective Cohort, 2010–2020

Abstract

OBJECTIVES: Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes. DESIGN: Retrospective cohort study. SETTING: PICU within a quaternary care hospital. PATIENTS: Pediatric patients (< 18 yr) admitted from January 2010 to December 2020 with TBI who underwent cEEG within 72 hours of admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient demographics, clinical parameters, hospital course, and cEEG features were reviewed for associations with mortality and new disability (as defined by change in Functional Status Score between admission and discharge of ≥ 3 points). A statistical prediction model for patient outcome was created combining cEEG parameters with admission Glasgow Coma Scale (GCS) score and radiographic findings. We included 142 patients: 100 (70%) of whom had no new disability at hospital discharge; 42 (30%) had a new disability, including eight deaths. Univariate analysis showed favorable outcomes were associated with normal electroencephalogram background, reactivity, and sleep features (p < 0.001 for each). A model inclusive of these electroencephalogram parameters and GCS had high predictive ability for outcome with 0.94 with 95% CI (0.90–0.98). CONCLUSIONS: Specific cEEG findings observed acutely after injury, in combination with other clinical characteristics, may serve as biomarkers for short-term functional outcomes after pediatric TBI. Further validation of the model in another population is now required.