{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T03:36:28Z","timestamp":1784345788398,"version":"3.55.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND<\/jats:title>\n            <jats:p>The study objective was to describe the epidemiology of serious concomitant injuries and their effects on outcome in pediatric severe traumatic brain injury (sTBI).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS<\/jats:title>\n            <jats:p>A retrospective cohort of all severely injured (Injury Severity Score [ISS] \u2265 12) pediatric patients (&lt;18 years) admitted to our pediatric intensive care unit, between 2000 and 2011, after experiencing an sTBI (Glasgow Coma Scale [GCS] score \u2264 8 and head Abbreviated Injury Scale [AIS] \u2265 4) were included. Two groups were compared based on the presence of serious concomitant injuries (maximum AIS score \u2265 3). Multivariate logistic regression was undertaken to determine variable associations with mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>Of the 180 patients with sTBI, 113 (63%) sustained serious concomitant injuries. Chest was the most commonly injured extracranial body region (84%), with lung being the most often injured. Patients with serious concomitant injuries had increased age, weight, and injury severity (<jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001) and were more likely injured in a motor vehicle collision (91% vs. 48%, <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001). Those with serious concomitant injuries had worse sTBI, based on lower presedation GCS (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.031), higher frequency of fixed pupils (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.006), and increased imaging abnormalities (SAH and DAI, <jats:italic toggle=\"yes\">p<\/jats:italic> \u2264 0.01). Non-neurosurgical operations and blood transfusions were more frequent in the serious concomitant injury group (<jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.01). The differences in mortality for the two groups failed to reach statistical significant (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.053), but patients with serious concomitant injuries had higher rates of infection and acute central diabetes insipidus, fewer ventilator-free days, and greater length of stays (<jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.05). Multivariate analyses revealed fixed pupillary response (odd ratio [OR], 63.58; <jats:italic toggle=\"yes\">p<\/jats:italic> &lt; 0.001), presedation motor GCS (OR, 0.23; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.001), blood transfusion (OR, 5.80; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.008), and hypotension (OR, 4.82; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.025) were associated with mortality, but serious concomitant injuries was not (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.283).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>Head injury is the most important prognostic factor in mortality for sTBI pediatric patients, but the presence of serious concomitant injuries does contribute to greater morbidity, including longer stays, more infections, fewer ventilator-free days, and a higher level of care required on discharge from hospital.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>LEVEL OF EVIDENCE<\/jats:title>\n            <jats:p>Prognostic and epidemiologic study, level III.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/ta.0b013e3182a685b0","type":"journal-article","created":{"date-parts":[[2013,10,24]],"date-time":"2013-10-24T07:23:57Z","timestamp":1382599437000},"page":"836-842","source":"Crossref","is-referenced-by-count":50,"title":["The role of serious concomitant injuries in the treatment and outcome of pediatric severe traumatic brain injury"],"prefix":"10.1097","volume":"75","author":[{"given":"Tanya Charyk","family":"Stewart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim M.","family":"Alharfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas D.","family":"Fraser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-13-20240122","first-page":"689","article-title":"A pediatric perspective on concussion pathophysiology. 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