Incidence and Risk Factors for Perioperative Hyperglycemia in Children with Traumatic Brain Injury

BACKGROUND: Hyperglycemia after traumatic brain injury (TBI) is associated with poor outcome. In this study, we examined the incidence and risk factors for perioperative hyperglycemia in children with TBI. METHODS: A retrospective cohort study of children <= 13 yr who underwent urgent or emergent craniotomy for TBI at Harborview Medical Center (level I Adult and Pediatric Trauma Center) between 1994 and 2004 was performed. Preoperative (emergency department to general anesthesia start), intraoperative (during general anesthesia), and immediate postoperative (first 24 h after surgery) glucose Values for each patient were retrieved. The incidence of hyperglycemia (glucose >= 200 mg/dL) and hyperglycemia (glucose <60 mg/dL) was determined Persistent. hyperglycemia was defined as hyperglycemia during any 2/3 (preoperative, intraoperative immediate postoperative) study periods, whereas transient hyperglycemia was hyperglycemia during any one study period. Multivariate logistic regression analysis was used to determine the independent predictors of perioperative hyperglycemia. Data are resented as adjusted odds ratio (AOR) (95% CI) and P < 0.05 reflects significance. RESULTS: At least one serum glucose value was recorded during each study period: preoperative (86 [82%]), intraoperative (94 [89%), and postoperative (101 [97%]). Sixty-four percent of children had less than one glucose recorded per anesthetic hour. Forty-seven (45%) children had hyperglycemia during at least one study period. Transient hyperglycemia occurred in 29 (28%) and persistent hyperglcemia Occurred in 18 (17%) children. Independent predictors of perioperative hyperglycemia were a e <4 yr (AOR 95% CI]; 3.5 [1.2-10.6]), Glasgow Coma Scale <= 8 (AOR 95%) CI; 7.2 [2.4-2.5]) and the presence of multi le lesions subdural hematoma (AOR 95%, CI; 34.7 [2.3-525.5]). Six children were treated with insulin, and two children had hypoglycemia, unrelated to insulin treatment. CONCLUSIONS: Perioperative hyperglycemia was common and intraoperative hypo glycemia was not rare, but More frequent intraoperative glucose sampling may be needed to better determine the incidence of hypo and hyperglycemia during the perioperative period. Age <4 yr, severe TBI a and the presence of multiple lesions, including subdural hematoma, were risk factors for perioperative hyperglycemia.