Table2_The neurological wake-up test in severe pediatric traumatic brain injury: a long term, single-center experience.docx

ObjectivesTo describe the use and outcomes of the neurological wake-up test (NWT) in pediatric severe traumatic brain injury (pTBI).
DesignRetrospective single-center observational cohort study.
SettingMedical-surgical tertiary pediatric intensive care unit (PICU) in a university medical center and Level 1 Trauma Center.
PatientsChildren younger than 18 years with severe TBI [i.e., Glasgow Coma Scale (GCS) of ≤8] admitted between January 2010 and December 2020. Subjects with non-traumatic brain injury were excluded.
Measurements and main resultsOf 168 TBI patients admitted, 36 (21%) met the inclusion criteria. Median age was 8.5 years [2 months to 16 years], 5 patients were younger than 6 months. Median initial Glasgow Coma Scale (GCS) and Glasgow Motor Scale (GMS) was 6 [3–8] and 3 [1–5]. NWTs were initiated in 14 (39%) patients, with 7 (50%) labelled as successful. Fall from a height was the underlying injury mechanism in those seven. NWT-failure occurred in patients admitted after traffic accidents. Sedation use in both NWT-subgroups (successful vs. failure) was comparable. Cause of NWT-failure was non-arousal (71%) or severe agitation (29%). Subjects with NWT failure subsequently had radiological examination (29%), repeat NWT (43%), continuous interruption of sedation (14%) or intracranial pressure (ICP) monitoring (14%). The primary reason for not doing NWTs was intracranial hypertension in 59%. Compared to the NWT-group, the non-NWT group had a higher PRISM III score (18.9 vs. 10.6), lower GCS/GMS at discharge, more associated trauma, and circulatory support. Nine patients (25%) died during their PICU admission, none of them had an NWT.
ConclusionWe observed limited use of NWTs in pediatric severe TBI. Patients who failed the NWT were indistinguishable from those without NWT. Both groups were more severely affected compared to the NWT successes. Therefore, our results may indicate that only a select group of severe pTBI patients qualify for the NWT.

研究目的：描述神经唤醒试验（Neurological Wake-up Test, NWT）在儿童重型创伤性脑损伤（pediatric Severe Traumatic Brain Injury, pTBI）中的应用与结局。
研究设计：回顾性单中心观察性队列研究。
研究机构：某大学附属医学中心的三级综合儿科重症监护室（Pediatric Intensive Care Unit, PICU）及一级创伤中心。
研究对象：2010年1月至2020年12月期间收治的18岁以下重型创伤性脑损伤患儿，即格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分≤8分者；排除非创伤性脑损伤受试者。
测量指标与主要结果：纳入的168例创伤性脑损伤患儿中，共36例（21%）符合纳入标准。患儿中位年龄为8.5岁（范围：2月龄至16岁），其中5例年龄小于6月龄。初始格拉斯哥昏迷量表（GCS）与格拉斯哥运动量表（Glasgow Motor Scale, GMS）中位评分分别为6分（3~8分）与3分（1~5分）。14例（39%）患儿实施了神经唤醒试验（NWT），其中7例（50%）试验成功。该7例成功病例的致伤机制均为高处坠落；试验失败病例均为道路交通伤致伤。两组NWT亚组（成功组与失败组）的镇静药物使用情况无显著差异。试验失败的原因包括未觉醒（71%）与严重躁动（29%）。试验失败的患儿后续接受了影像学检查（29%）、重复NWT（43%）、持续中断镇静治疗（14%）或颅内压（Intracranial Pressure, ICP）监测（14%）。未实施NWT的主要原因为颅内高压（59%）。与NWT组相比，非NWT组的儿科危重症评分III（PRISM III）更高（18.9 vs. 10.6），出院时GCS/GMS评分更低，合并创伤更多，且更多需要循环支持。9例（25%）患儿在PICU住院期间死亡，均未接受NWT。
结论：本研究观察到，神经唤醒试验（NWT）在儿童重型创伤性脑损伤（pTBI）中的应用较为有限。试验失败患儿与未接受NWT的患儿临床特征无显著差异；与试验成功患儿相比，这两类患儿的病情均更为危重。因此，本研究结果提示，仅部分符合筛选条件的儿童重型创伤性脑损伤患者可接受NWT。