Association of left ventricular systolic dysfunction with outcome following pediatric traumatic brain injury

OBJECTIVE: Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality in children. While left ventricular systolic dysfunction (LVSD) has been observed following TBI in adults, very little is known regarding it in the pediatric TBI population. The aim of this study was to evaluate the frequency and admission risk factors for systolic dysfunction following pediatric TBI. The authors hypothesized that systolic cardiac dysfunction would be associated with morbidity and mortality. METHODS: This was a single-center retrospective observational study from a quaternary children's hospital. Pediatric patients with TBI who were younger than 18 years and had a transthoracic echocardiogram obtained by the pediatric cardiology team from January 2011 to December 2021 were evaluated. The primary outcome was in-hospital mortality. The secondary outcome was the Glasgow Outcome Scale-Extended (GOS-E) score at 6 months in survivors. RESULTS: Of 1059 pediatric patients who presented with TBI, 70 had an echocardiogram, all of which were obtained within 72 hours of admission. LVSD on the echocardiogram was observed in 24 of 70 patients (34%). The mortality rate was 47% (33 of 70). Low admission Glasgow Coma Scale (GCS) score, abusive head trauma, and cardiac arrest were independent risk factors associated with a higher odds of LVSD on univariate analysis, while a low admission GCS score was also a risk factor on multivariate analysis (p < 0.05). Systolic cardiac dysfunction increased the odds for in-hospital mortality or worse outcome (low GOS-E score) in survivors at 6 months on univariate analysis (p < 0.05). When accounting for admission GCS scores, abusive head trauma, and cardiac arrest on multivariate analysis, LVSD did not have a significant association with mortality and morbidity. CONCLUSIONS: Nearly 35% of pediatric TBI patients who underwent transthoracic echocardiography were found to have LVSD within 72 hours of admission. Low admission GCS score, abusive head trauma, or cardiac arrest significantly increased the risk of LVSD on univariate analysis, while the GCS score was a risk factor on multivariate analysis. The presence of LVSD was associated with an increased risk of mortality and morbidity in survivors on univariate analysis. Future prospective studies are warranted to further characterize myocardial dysfunction in pediatric patients with TBI and determine whether earlier recognition and treatment might improve outcomes.