Cerebral rSO₂ monitoring in pediatric altered mental status patients

Introduction

Pediatric patients with altered mental status (AMS) present with poor histories resulting in delayed testing and potential poor outcomes. Non-invasive detection for altered cerebral physiology related to TBI would improve resuscitation and outcome. Cerebral rSO₂ (r_cSO₂) studies demonstrate its utility in certain neurological emergencies.

Methods

A retrospective analysis of r_cSO₂ utility in AMS. rcSO₂ data were collected every 30 seconds for AMS patients who had a head CT. Patients with a negative head CT were compared with those with an abnormal head CT. ROC analysis was performed to find the AUC for each summary statistic and performance characteristics. Subgroup analysis was done to determine whether r_cSO₂ predicted injury and location.

Results

r_cSO₂ readings across 5, 15, 20, and 30 minutes were stable (Figure 1). r_cSO₂ readings with one or both sides <50% or a wide difference between L and R cerebrum was predictive of an abnormal CT scan. A mean difference of 4.2 was 82% sensitive for detecting a CT lesion with 62% specificity, 88% PPV, and 52% NPV; a mean difference of 12.2 was 100% specific for an abnormal head CT. Lower mean r_cSO₂ readings localized to the CT pathology side, and higher r_cSO₂ readings trend toward the EDH group.

Conclusion

Cerebral rcSO₂ monitoring can non-invasively detect altered cerebral physiology and pathology related to TBI as the cause for pediatric altered mental status. The utility of r_cSO₂ monitoring has shown its potential for localizing and characterizing intracranial lesions among these altered children. Further studies utilizing r_cSO₂ monitoring as an adjunct tool in pediatric altered mental status evaluation and management are ongoing.

Figure 1

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