A high blood glucose is common in actually ill neurological patients, even in
non-diabetics. A consensus regarding the cut-off blood glucose level that would
be related to poor prognosis in children and adolescent with head trauma, which
makes the comparison of different studies important. Objective:
Prevalence of acute hyperglycemia and Glasgow coma scale (GCS) in Pediatric
Traumatic brain injury in the Emergency Room. Method: Prospective
cross-sectional study of pediatric head injury patients in the emergency room
during one year period. The cut-off value of 150 mg/dL to define hyperglycemia
was considered. Results: A total of 440 children were included and 65 had
admission hyperglycemia. Hyperglycemia was present in 11% of mild head trauma
cases; 35% of those with moderate head trauma and 54% of severe head trauma. In
this study, observed that among children with higher blood glucose levels, 83%
had abnormal findings on cranial computed tomography scans. The prevalence of hyperglycemia is
higher in patients with severe head trauma, as well as in those with abnormal
findings on CCT scans. Conclusion: Hyperglycemia was
more prevalent in severe head trauma (GCS ≤8), regardless of etiology of
trauma, mode of injury or multiple trauma in children with abnormal findings on
head computed tomography scans.
adolescents, children, head trauma, hyperglycemia, prevalence
. Bochicchio GV, Sung J, Joshi M.
Persistent hyperglycemia is predictive of outcome in critically ill trauma
patients. J Trauma (2005); 58; 921-924.
. Bochicchio GV, Joshi M, Bochicchio KM.
Early hyperglycemic control is important in critically injured trauma patients.
J Trauma (2007); 63; 1353-1358.
. Chiaretti A, De BR, Langer A. Prognostic
implications of hyperglycaemia in paediatric head injury. Childs NervSyst (1998); 14:455-459.
. Chiaretti A, Piastra M, Pulitano S.
Prognostic factors and outcome of children with severe head injury: an 8-year
experience. Childs NervSyst (2002); 18:129-136.
. Cochran A, Scaife ER, Hansen KW, Downey
EC. Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma (2003); 55: 1035-1038.
. Durr JA, Hoffman WH, Sklar AH, Steinhart
CM. Correlates of brain edema in uncontrolled IDDM. Diabetes (1992); 41; 627-632.
. Epstein J, Breslow MJ. The stress
response of critical illness. Crit Care Clin (1999); 15; 17-33. 20. Hirsch IB.
. Jeremitsky E, Omert LA, Dunham CM, Wilberger
J, Rodriguez A. The impact of hyperglycemia on patients with severe brain
injury. J Trauma (2005); 58; 47-50.
. Kuzuya T, Nakagawa S, Satoh J. Report of
the Committee on the classification and diagnostic criteria of diabetes
mellitus. Diabetes Res ClinPract (2002);
. Kushner M, Nencini P, Reivich M.
Relation of hyperglycemia early in
ischemic brain infarction to cerebral anatomy, metabolism, and clinical
outcome. Ann Neurol (1990); 28:
. Lam AM, Winn HR, Cullen BF, Sundling N.
Hyperglycemia and neurological outcome in patients with head injury. J
Neurosurg (1991); 75: 545-551.
. Laird AM, Miller PR, Kilgo PD, Meredith
JW, Chang MC. Relationship of early hyperglycemia to mortality in trauma
patients. J Trauma (2004); 56; 1058-1062.
. Marcoux KK. Management of increased
intracranial pressure in the critically ill child with an acute neurological
injury. AACN Clin Issues (2005); 16:212-231.
. Melo JR, Santana DL, Pereira JL, Ribeiro
TF. [Traumatic brain injury in children and adolescents at Salvador City,
Bahia, Brazil]. Arq Neuropsiquiatr (2006);
. Melo JR, Silva RA, Moreira ED Jr.
[Characteristics of patients with head injury at Salvador City
(Bahia--Brazil)]. Arq Neuropsiquiatr (2004);
. In-patient hyperglycemia--are we ready
to treat it yet? J ClinEndocrinolMetab (2002);87;
. Orliaguet GA, Meyer PG, Baugnon T.
Management of critically ill children with traumatic brain injury.
PaediatrAnaesth (2008);18 :455-461.
. Parish RA, Webb KS. Hyperglycemia is not
a poor prognostic sign in head-injured children. J Trauma (1988);28:517-519.
. Parejo P, Stahl N, Xu W, Reinstrup P,
Ungerstedt U, Nordstrom CH. Cerebral energy metabolism during transient
hyperglycemia in patients with severe brain trauma. Intensive Care Med (2003); 29; 544-550.
. Sung J, Bochicchio GV, Joshi M,
Bochicchio K, Tracy K, Scalea TM. Admission hyperglycemia is predictive of
outcome in critically ill trauma patients. J Trauma (2005); 59:80-83.
. Schelp AO, Burini RC. [Cerebral glucose
metabolism in craniocerebral trauma: an evaluation]. Arq Neuropsiquiatr (1995);53:698-705.
. Teasdale G, Jennett B. Assessment of
coma and impaired consciousness. A practical scale. Lancet (1974)13; 7872; 81-84.
. Tominaga M. Diagnostic criteria for
diabetes mellitus]. RinshoByori (1999);
. Umpierrez GE, Isaacs SD, Bazargan N, You
X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital
mortality in patients with undiagnosed diabetes. J ClinEndocrinolMetab (2002); 87; 978-982.
. Yamaguchi N. Sympathoadrenal system in
neuroendocrine control of glucose: mechanisms involved in the liver, pancreas
and adrenal gland under hemorrhagic and hypoglycemic stress. Can J
. World Health Organization. Child and
adolescent health and development. Available at (http:///www.who.int/en/) Accessed November 01, (2007).