{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:35:26Z","timestamp":1782866126422,"version":"3.54.5"},"reference-count":36,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,2,8]]},"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We tested whether Cushing\u2019s sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study using Japan Trauma Data Bank.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Emergency and critical care centres in secondary and tertiary hospitals in Japan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary outcome measures<\/jats:title><jats:p>Patients requiring neurosurgical intervention within 24\u2009hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP \u2265135\u2009mm Hg; HR \u226492\u2009bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P&lt;0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7\u201310 and 11\u201315 years of age; however, no significant association was observed in a group of 2\u20136 years of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cushing\u2019s sign after blunt trauma was significantly associated with BI-NSI in school-age children and young adolescents.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2017-020781","type":"journal-article","created":{"date-parts":[[2018,3,3]],"date-time":"2018-03-03T11:50:54Z","timestamp":1520077854000},"page":"e020781","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Cushing\u2019s sign and severe traumatic brain injury in children after blunt trauma: a nationwide retrospective cohort study in Japan"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-8026","authenticated-orcid":false,"given":"Tetsuya","family":"Yumoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromichi","family":"Naito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Yorifuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Maeyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Kosaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotsugu","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Tsukahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Osako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsunori","family":"Nakao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,3,3]]},"reference":[{"key":"2024051711574884000_8.3.e020781.1","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-200611000-00009"},{"key":"2024051711574884000_8.3.e020781.2","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.wneu.2016.03.045","article-title":"Wellons JC 3rd, Bonfield CM. 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