Hiperglicemia como indicador de mau prognóstico após TCE grave em crianças: uma revisão sistemática

Abstract

Head trauma is a major cause of death or disability in childhood and several markers have been studied to help predicting the prognosis after trauma, including hyperglycemia, which has been shown to indicate a worse clinical outcome, as well as of prolonged duration of mechanical ventilation and intensive care stay. Objective: To describe hyperglycemia as a predictor of mortality and / or poor prognosis after severe TBI in children and adolescents up to the age of 18 years. Methodology: This is a systematic review, where bibliographic sources were used, searched in databases: SCIELO, PUBMED and LILACS, complemented by manual addition of articles. The keywords used were related to hyperglycemia after severe traumatic brain injury in the pediatric age group. Articles in English and Portuguese, in the publication period from January 2008 to January 2018, were accepted. Results: According to the descriptors used, 39 articles were initially found and, after manual inclusion of an article, and application of the inclusion and non-inclusion processes, 08 articles were selected. The studies brought to the analysis and discussion the involvement of hyperglycemia in the first hours after the TBI, with clinical outcome of the patient. Discussion: Hyperglycemia in children with severe TBI was well established as a worse clinical outcome, characterized as an extension of hospitalization, intubation and death time. The relationship between the severity of the lesion and the increase in serum glucose was demonstrated. It was therefore possible to suspect that hyperglycemia in the first 48 hours is a strong predictor of mortality after moderate to severe TBI in children. Conclusion: The literature demonstrates that hyperglycemia can be a predictor of mortality and poor prognosis in the scenario of severe TBI, especially in the first 48 hours after the accident. Further studies are needed to establish protocols and indications for the treatment of hyperglycemia in traumatized children.