Research Reports - Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury

J Neurotrauma. 2013 Mar 1;30(5):361-6

Alharfi IM, Stewart TC, Kelly SH, Morrison GC, Fraser DD

Acquired hypernatremia in hospitalized patients is often associated with poorer
outcomes. Our aim was to evaluate the relationship between acquired hypernatremia
and outcome in children with severe traumatic brain injury (sTBI). We performed a
retrospective cohort study of all severely injured trauma patients (Injury
Severity Score ≥12) with sTBI (Glasgow Coma Scale [GCS] ≤8 and Maximum
Abbreviated Injury Scale [MAIS] ≥4) admitted to a Pediatric Critical Care Unit
([PCCU]; 2000-2009). In a cohort of 165 patients, 76% had normonatremia (135-150
mmol/L), 18% had hypernatremia (151-160 mmol/L), and 6% had severe hypernatremia
(>160 mmol/L). The groups were similar except for lower GCS (p=0.002) and
increased incidence of fixed pupil(s) on admission in both hypernatremia groups
(p<0.001). Mortality rate was four-fold and six-fold greater with hypernatremia
and severe hypernatremia, respectively (p<0.001), and mortality rates were
unchanged when patients with fixed pupils or those with central diabetes
insipidus were excluded (p<0.001). Hypernatremic patients had fewer
ventilator-free days (p<0.001). Survivors with hypernatremia had greater PCCU
(p=0.001) and hospital (p=0.031) lengths of stays and were less frequently
discharged home (p=0.008). Logistic regression analyses of patient
characteristics and sTBI interventions demonstrated that hypernatremia was
independently associated with the presence of fixed pupil(s) on admission (odds
ratio [OR] 5.38; p=0.003); administration of thiopental (OR 8.64; p=0.014), and
development of central diabetes insipidus (OR 5.66; p=0.005). Additional logistic
regression analyses demonstrated a significant association between hypernatremia
and mortality (OR 6.660; p=0.034). In summary, acquired hypernatremia appears to
signal higher risk of mortality in pediatric sTBI and is associated with a higher
discharge level of care in sTBI survivors.

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