Hypothermia for Head Trauma in Children
Hypothermia therapy did not improve neurologic outcomes in children with traumatic brain injury and might have contributed to increased mortality.
Both animal studies and studies involving limited numbers of children suggest that hypothermia might improve neurologic outcomes after head trauma. In an international trial, researchers randomized 225 children (age range, 1–17 years) with traumatic brain injury (Glasgow Coma Scale score 8) to receive either hypothermia therapy (esophageal temperature, 32.5°C for 24 hours) initiated within 8 hours after injury or routine care (normothermia).
At 6 months after discharge, an unfavorable outcome (severe disability, persistent vegetative state, or death) was more likely in the hypothermia group than in the normothermia group (31% vs. 22%; P=0.14). Mortality was greater in the hypothermia group than in the control group (21% vs. 12%; P=0.06).
Hypothermia, as used in this study, did not improve neurologic outcomes — and possibly increased mortality — in children with traumatic brain injury. Whether earlier or more-sustained hypothermia would be more effective is unclear. Note that hypothermia was also ineffective in a study conducted in adults with traumatic brain injury (JW Emerg Med Apr 18 2001).
Howard Bauchner, MD
Published in Journal Watch Pediatrics and Adolescent Medicine June 4, 2008
Citation(s): Hutchison JS et al. Hypothermia therapy after traumatic brain injury in children. N Engl J Med 2008 Jun 5; 358:2447.