Background: 

The relationship between cerebral autoregulation and outcomes in pediatric complex mild traumatic brain injury (TBI) is unknown, and explored in this study.

Methods: 

We conducted a prospective observational study of patients aged 0 to 18 years hospitalized with complex mild TBI (admission Glasgow Coma Scale score 13 to 15 with either abnormal computerized tomogram of the head or history of loss of consciousness). Cerebral autoregulation was tested using transcranial Doppler ultrasonography, and impaired autoregulation defined as autoregulation index<0.4. We collected Glasgow Outcome Scale Extended-Pediatrics score and health-related quality of life data at 3, 6, and 12 months after discharge.

Results: 

Twenty-four patients aged 1.8 to 16.6 years (58.3% male) with complete 12-month outcome data were included in the analysis. Median admission Glasgow Coma Scale score was 15 (range: 13 to 15), median injury severity score was 12 (range: 4 to 29) and 23 patients (96%) had isolated TBI. Overall, 10 (41.7%) patients had impaired cerebral autoregulation. Complete recovery was observed in 6 of 21 (28.6%) children at 3 months, in 4 of 16 (25%) children at 6 months, and in 8 of 24 (33.3%) children at 12 months. There was no difference in median (interquartile range) Glasgow Outcome Scale Extended-Pediatrics score (2 [2.3] vs. 2 [interquartile range 1.3]) or health-related quality of life scores (91.5 [21.1] vs. 90.8 [21.6]) at 12 months between those with intact and impaired autoregulation, respectively. Age-adjusted hypotension occurred in 2/24 (8.3%) patients.

Conclusion: 

Two-thirds of children with complex mild TBI experienced incomplete functional recovery at 1 year. The co-occurrence of hypotension and cerebral autoregulation may be a sufficiency condition needed to affect TBI outcomes.

中文翻译：

---

复杂轻度创伤性脑损伤儿童的大脑自动调节和 12 个月结果的试点前瞻性观察研究：影响 TBI 结果的充分条件的论点

背景： 

大脑自动调节与儿童复杂性轻度创伤性脑损伤 (TBI) 结局之间的关系尚不清楚，本研究对此进行了探讨。

方法： 

我们对因复杂轻度 TBI 住院的 0 至 18 岁患者（入院时格拉斯哥昏迷量表评分为 13 至 15，头部计算机断层扫描异常或有意识丧失病史）进行了一项前瞻性观察研究。使用经颅多普勒超声检查测试大脑自动调节，自动调节受损定义为自动调节指数<0.4。我们收集了出院后 3、6 和 12 个月的格拉斯哥结果量表扩展儿科评分和健康相关生活质量数据。

结果： 

分析中包括 24 名年龄在 1.8 至 16.6 岁之间的患者（58.3% 为男性），具有完整的 12 个月结果数据。入院格拉斯哥昏迷量表评分中位数为 15（范围：13 至 15），损伤严重程度评分中位数为 12（范围：4 至 29），23 名患者 (96%) 患有孤立性 TBI。总体而言，10 名（41.7%）患者的大脑自动调节功能受损。3 个月时，21 名儿童中有 6 名 (28.6%) 完全康复，6 个月时，16 名儿童中有 4 名 (25%) 完全康复，12 个月时，24 名儿童中有 8 名 (33.3%) 完全康复。中位数（四分位距）格拉斯哥结果量表扩展儿科评分（2 [2.3] vs. 2 [四分位距 1.3]）或健康相关生活质量评分（91.5 [21.1] vs. 90.8 [21.6]）没有差异）分别在 12 个月时在自动调节功能完好和受损的患者之间进行。2/24 (8.3%) 患者发生年龄调整低血压。

结论： 

三分之二的患有复杂轻度 TBI 的儿童在 1 岁时经历了不完全的功能恢复。低血压和脑自动调节的同时发生可能是影响 TBI 结局所需的充分条件。