What question did this study set out to answer?

To assess the predictive value of continuous EEG and Rotterdam head CT scores for early favorable outcomes in pediatric severe traumatic brain injury.

March 26, 2026

17: Eeg Reactivity and Rotterdam Head Ct Score Predict Early Favorable Outcome in Pediatric Severe Tbi

Key Points

To assess the predictive value of continuous EEG and Rotterdam head CT scores for early favorable outcomes in pediatric severe traumatic brain injury.
Conducted a 7-year retrospective study in a PICU involving children aged 1.5-18 years with severe TBI receiving continuous EEG monitoring.
Recorded cEEG features during the first 12 hours and initial Rotterdam head CT scores.
Collected demographic and clinical data, including GCS score, pupillary reactivity, and ISS.
Analyzed associations using Chi-square, Fischer Exact tests, and logistic regression methods.
Out of 54 patients, 76% survived; significant predictors for favorable outcomes included reactivity on cEEG and a Rotterdam CT score < 3.
Presence of reactivity was associated with a higher odds ratio (9.93), indicating a strong link to favorable outcomes.
A lower Injury Severity Score (ISS) was inversely associated with favorable outcomes (OR 0.88).

Abstract

Introduction: Accurate prognostication after pediatric severe TBI (sTBI) remains challenging. We examined the utility of continuous EEG (cEEG) and Rotterdam head CT score in predicting short-term favorable outcome. Methods: 7-yr (01/2018-12/2024) retrospective study of children aged 1.5-18 yrs admitted to our PICU with sTBI and receiving cEEG monitoring per institutional protocol. Early favorable outcome was defined as Pediatric Cerebral Performance Category scale 1-3 at PICU discharge. cEEG features (background, sleep architecture, reactivity, and seizure) during the 1st 12-hrs of monitoring and initial Rotterdam head CT scores were recorded. Demographics, GCS score, pupillary reactivity, injury severity score (ISS), clinical seizure, cardiac arrest, and neurosurgical intervention data were collected. Significant associations with favorable outcome were analyzed by Chi-square or Fischer Exact tests for categorial data or univariate logistic regression for continuous data. A stepwise multiple logistic regression analysis was performed to determine significant independent associations with favorable outcome. Results: 54 patients were studied. Median IQR age: 8.9 4.5-14.8 yrs; initial GCS score: 3 3-6; and Rotterdam head CT score: 3 2-5; 33 (61%) were male; 12 (22%) had clinical seizures; 28 (52%) received neurosurgical intervention; and 41 (76%) survived. In univariate analysis, favorable outcome was significantly associated (OR95%CI) with GCS (1.43 1.04-1.97, p=0.029); pupillary reactivity (9.0 1.77-45.71, p=0.005); Rotterdam CT score < 3 (7.14 1.72-29.68, p=0.006); and presence of reactivity (20.0 4.95-80.89, p< 0.001) and absence of seizure (undefined ~12.4, p=0.02) on cEEG; and inversely associated with ISS (0.87 0.81-0.94, p< 0.001) and neurosurgical intervention (0.188 0.06-0.57, p=0.004). Stepwise logistic regression revealed significant independent associations with favorable outcome for presence of reactivity on cEEG (9.93 1.83-53.82, p=0.008) and Rotterdam CT score < 3 (12.14 1.02-145.10, p=0.049), and an inverse association for ISS (0.88 0.80-0.97, p=0.009). Conclusions: Reactivity on cEEG, Rotterdam head CT score < 3, and lower ISS independently predict early favorable outcome and may enhance future development of better neuroprognostication models in pediatric sTBI.

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Cite This Study

Lu et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4cdcdfdc3bde44891a97c https://doi.org/https://doi.org/10.1097/01.ccm.0001182260.63558.0c

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