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10.1097/PCC.0000000000000709 http://scihub22266oqcxt.onion/10.1097/PCC.0000000000000709 C4856573!4856573!27028792     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=27028792&cmd=llinks): Failed to open stream: HTTP request failed! 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Intracranial Hypertension and Cerebral Hypoperfusion in Children with Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults |pdf=|usr=}}{{27028792}} gab.com Text Intracranial Hypertension and Cerebral Hypoperfusion in Children with Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults JO: Pediatr Crit Care Med http://www.kidney.de/pget.php?&tw=1&pmid=27028792 #FOAvip Objective: The evidence to guide therapy in pediatric TBI is lacking, including insight into the ICP/CPP thresholds in abusive head trauma (AHT). We examined ICP/CPP thresholds and indices of ICP and CPP burden in relationship to outcome in severe TBI and in accidental and AHT cohorts. Design: A prospective observational study. Setting: PICU in a tertiary children?s hospital. Patients: Children <18y admitted to PICU with severe TBI and had ICP monitoring. Measurements and Main Results: A pediatric TBI database was interrogated with 85 patients (18 AHT) enrolled. Hourly ICP and CPP (in mm Hg) were collated and compared to various thresholds. C-statistics for ICP and CPP data in the entire population were determined. Intracranial hypertension and cerebral hypoperfusion indices were formulated based on number of hours with ICP>20 and CPP<50, respectively. A secondary analysis was performed on accidental and AHT cohorts. All of these were compared with dichotomized 6 month GOS scores. The models with the number of hours with ICP>20 (C=0.641, 95% confidence interval: 0.523, 0.762) and CPP<45 (C=0.702, 95% confidence interval: 0.586, 0.805) had the best fits to discriminate outcome. Two factors were independently associated with a poor outcome, number of hours ICP>20 and AHT (OR=5.101, 95% CI: 1.571, 16.563). As the number of hours with ICP>20 increase by 1, the odds of a poor outcome increased by 4.6% (OR=1.046, 95% CI: 1.012, 1.082). Thresholds did not differ between accidental vs. AHT. The intracranial hypertension and cerebral hypoperfusion indices were both associated with outcome. Conclusion: The duration of hours of ICP>20 and CPP<45 best discriminated poor outcome. As the number of hours ICP>20 increase by 1, the odds of a poor outcome increased by 4.6%. Although AHT was strongly associated with unfavorable outcome, ICP/CPP thresholds did not differ between accidental and AHT. Twit Text FOAVip Intracranial Hypertension and Cerebral Hypoperfusion in Children with Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults ????Pediatr Crit Care Med http://www.kidney.de/pget.php?&tw=1&pmid=27028792 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27028792 #FOAvip English Wikipedia <ref>{{Cite pmid|27028792}}</ref> Intracranial Hypertension and Cerebral Hypoperfusion in Children with Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults #MMPMID27028792 Ferguson NM; Shein SL; Kochanek PM; Luther J; Wisniewski SR; Clark RSB; Tyler-Kabara EC; Adelson PD; Bell MJ Pediatr Crit Care Med 2016[May]; 17 (5): 444-50 PMID27028792show ga Objective: The evidence to guide therapy in pediatric TBI is lacking, including insight into the ICP/CPP thresholds in abusive head trauma (AHT). We examined ICP/CPP thresholds and indices of ICP and CPP burden in relationship to outcome in severe TBI and in accidental and AHT cohorts. Design: A prospective observational study. Setting: PICU in a tertiary children?s hospital. Patients: Children <18y admitted to PICU with severe TBI and had ICP monitoring. Measurements and Main Results: A pediatric TBI database was interrogated with 85 patients (18 AHT) enrolled. Hourly ICP and CPP (in mm Hg) were collated and compared to various thresholds. C-statistics for ICP and CPP data in the entire population were determined. Intracranial hypertension and cerebral hypoperfusion indices were formulated based on number of hours with ICP>20 and CPP<50, respectively. A secondary analysis was performed on accidental and AHT cohorts. All of these were compared with dichotomized 6 month GOS scores. The models with the number of hours with ICP>20 (C=0.641, 95% confidence interval: 0.523, 0.762) and CPP<45 (C=0.702, 95% confidence interval: 0.586, 0.805) had the best fits to discriminate outcome. Two factors were independently associated with a poor outcome, number of hours ICP>20 and AHT (OR=5.101, 95% CI: 1.571, 16.563). As the number of hours with ICP>20 increase by 1, the odds of a poor outcome increased by 4.6% (OR=1.046, 95% CI: 1.012, 1.082). Thresholds did not differ between accidental vs. AHT. The intracranial hypertension and cerebral hypoperfusion indices were both associated with outcome. Conclusion: The duration of hours of ICP>20 and CPP<45 best discriminated poor outcome. As the number of hours ICP>20 increase by 1, the odds of a poor outcome increased by 4.6%. Although AHT was strongly associated with unfavorable outcome, ICP/CPP thresholds did not differ between accidental and AHT. äIntracranial Hypertension and Cerebral Hypoperfusion in Children with (epmc).pdf DeepDyve Pubget Overpricing