(903) Association of Left Ventricular Systolic Function and Outcome After Pediatric Traumatic Brain Injury

Introduction: Traumatic brain injury [TBI] is one of the leading causes of morbidity and mortality in children. While left ventricular [LV] systolic cardiac dysfunction has been observed following TBI in adults, very little is known regarding the pediatric TBI population. We hypothesized that LV systolic dysfunction following pediatric TBI would be associated with morbidity and mortality.

Methods: This was a single-center retrospective study from a quaternary children's hospital. Pediatric TBI patients less than 18 years who had a trans thoracic echocardiography obtained by pediatric cardiology within 72 hours of admission to the PICU from January 2011 to December 2021 were evaluated. The primary outcome was in-hospital mortality. Secondary outcomes included Glasgow outcome scale-extended score [GOS-E] at 6 months in survivors.

Results: Eighty-two pediatric TBI patients had an echocardiogram within 72 hours of admission. Cardiac abnormalities on echocardiogram were observed in 34 out of 82 patients (41%): 16 children had moderate to severe LV systolic dysfunction, 2 had mild LV systolic dysfunction, 7 had low to normal LV systolic dysfunction, 7 had hyperdynamic systolic function and 2 had isolated right ventricular dysfunction. The mortality rate was 45% (37 of 82). Clinical factors associated with LV systolic dysfunction included low admission GCS, intracranial hemorrhage, abusive head trauma, and cardiac arrest (p < 0.05). Moderate to severe LV systolic dysfunction had the highest odds ratio of mortality (OR 14.7, p = 0.018) and poor GOS-E at 6 months in survivors (OR 1.4, p = 0.03).

Conclusions: Almost 25% of pediatric TBI patients receiving transthoracic echocardiography developed LV systolic dysfunction within 72 hours of admission in our single-center retrospective study. Moderate to severe LV systolic dysfunction was associated with increased mortality and morbidity. Future prospective studies are warranted to further characterize myocardial dysfunction in pediatric TBI and determine whether earlier recognition and treatment may improve outcomes.