REVIEW

Initial Hemoglobin Levels as a Prognostic Indicator for Pediatric Traumatic Brain Injury: a systematic review and meta-analysis

Níveis Iniciais de Hemoglobina como Indicador Prognóstico para Lesão Cerebral Traumática Pediátrica: uma revisão sistemática e meta-análise

  • Cindy Thiovany Soetomo 1    Cindy Thiovany Soetomo 1
  • Made Favian Budi Gunawan 1    Made Favian Budi Gunawan 1
  • Putu Emilia Dewi 1    Putu Emilia Dewi 1
  • Agung Bagus Sista Satyarsa 2    Agung Bagus Sista Satyarsa 2
  • Dewa Putu Wisnu Wardhana 3    Dewa Putu Wisnu Wardhana 3
  • Rohadi Muhammad Rosyidi 4    Rohadi Muhammad Rosyidi 4
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Resumo

A lesão cerebral traumática (LCT) é uma causa significativa de morbidade e mortalidade na população pediátrica. A hemoglobina, essencial para o transporte de oxigênio, impacta o fluxo sanguíneo cerebral (FSC) e a recuperação cerebral. Apesar de sua medição rotineira em emergências, o valor prognóstico da hemoglobina permanece pouco explorado. Este estudo visa avaliar o valor prognóstico dos níveis iniciais de hemoglobina em pacientes pediátricos com LCT e seu potencial como preditores de mortalidade. Uma busca sistemática foi realizada em janeiro de 2024 através do PubMed, Cochrane e ScienceDirect, seguindo as diretrizes PRISMA. Foram incluídos estudos que relataram níveis iniciais de hemoglobina e desfechos em pacientes pediátricos com LCT. A meta-análise foi conduzida usando o software RevMan 5.4 para analisar a Razão de Chances (RC) para o desfecho, enquanto a análise do risco de viés foi conduzida usando o Newcastle-Ottawa Score (NOS). Cinco estudos envolvendo 780 crianças com menos de 18 anos foram incluídos nesta revisão sistemática e meta-análise. Os níveis iniciais de hemoglobina aumentaram significativamente o risco de mortalidade em LCT pediátrica, com uma razão de chances de 2,56 (IC 95% [1,13;5,80], p = 0,02). Todos os estudos apresentaram baixo risco de viés, reforçando a confiabilidade desses achados. Nossa análise demonstrou que os níveis iniciais de hemoglobina são um bom indicador prognóstico de mortalidade em pacientes pediátricos com LCT, e níveis mais baixos de hemoglobina na admissão aumentaram significativamente o risco de mortalidade. Esses achados sugerem que monitorar os níveis de hemoglobina na admissão pode ser crucial para a estratificação precoce de risco e manejo em casos de LCT pediátrica.  

Palavras-chave

Hemoglobina inicial; Pediátrico; Lesão cerebral traumática; Mortalidade

Abstract

Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality in the pediatric population. Hemoglobin, essential for oxygen transport, impacts cerebral blood flow (CBF) and brain recovery. Despite its routine measurement in emergencies, hemoglobin’s prognostic value remains underexplored. This study aims to assess the prognostic value of initial hemoglobin levels in pediatric TBI patients and their potential as predictors of mortality. A systematic search was performed in January 2024 through PubMed, Cochrane, and ScienceDirect adhering to the PRISMA guidelines. Studies that reported initial hemoglobin levels and outcomes in pediatric patients with TBI were included. Meta-analysis was conducted using RevMan software 5.4 to analyze the Odd Ratio (OR) for the outcome, while risk of bias analysis was conducted using Newcastle-Ottawa Score (NOS). Five studies involving 780 children under 18 were included in this systematic review and meta-analysis. Initial hemoglobin levels were found to significantly increase the risk of mortality in pediatric TBI, with an odds ratio of 2.56 (95% CI [1.13;5.80], p = 0.02). All studies had a low risk of bias, reinforcing the reliability of these findings. Our analysis demonstrated that initial hemoglobin levels are a good prognostic indicator for mortality in pediatric patients with TBI, and lower hemoglobin levels at admission significantly increased the risk of mortality. These findings suggest that monitoring hemoglobin levels upon admission could be crucial for early risk stratification and management in pediatric TBI cases.

Keywords

Initial hemoglobin; Pediatric; Traumatic brain injury; Mortality

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1Faculty of Medicine, Udayana University, Bali, Indonesia.

2Neurosurgery Division, Department of Surgery, Faculty of Medicine, Prof. Dr. IGNG Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia.

3Neurosurgery Division, Department of Surgery, Faculty of Medicine, Udayana University Hospital, Universitas Udayana, Badung, Bali, Indonesia.

4Department of Neurosurgery, Faculty of Medicine, Mataram University, West Nusa Tenggara, Indonesia.

 

Received July 26, 2024

Accepted Aug 2, 2024

JBNC  Brazilian Journal of Neurosurgery

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  •   e-ISSN (online version): 2446-6786
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