SYSTEMIC HYPERTENSION ASSOCIATED WITH POOR OUTCOME AFTER ACUTE BRAIN INJURY

Abstract

We studied intensive care unit (ICU) records of 42 children with Glasgow Coma Score ≤ 7 to better define the relation between high blood pressure (BP) and poor neurologic outcome following acute brain injury. Diagnoses included Reyes Syndrome (10), head trauma (16), anoxia (13) and CNS infection (3) and excluded those dying of circulatory failure. Corrected peak BP (in mmHg): BPc=(peak systolic BP)-(systolic BP 95%ile for age), was recorded in each 6 hour interval. Persistence of high BP was defined as BP >95%ile in 2 successive 6 hour intervals. Outcome was classified as good (mild or no deficit) or poor (death or severe neurologic deficit making patient dependent on special care). All patients' highest BP exceeded 95%ile. Highest BPc was: 1-20 in 8/42 (19%), 21-40 in 19/42 (45%), and >40 in 15/42 (36%). In those with highest BPc >20, poor outcome occurred in 19/34 (56%) while in those with highest BPc ≤ 20, poor outcome occurred in only 1/8 (13%)(p = .0316). Of those with high BP persisting until ICU discharge, 14/19 (74%) had poor outcome, while those with BP normalizing prior to ICU discharge had poor outcome in only 6/23 (26%) (p =.0026). Mean BPc in those with poor outcome tended to exceed mean BPc in patients with good outcome in each time interval from day 4 onward, with the difference reaching p<.05 on days 7,9 and 10. Severity as well as persistence of high BP identify patients with poor outcome after acute brain injury. This finding justifies further attempts to test the benefit of controlling high BP in the brain injured patient.

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