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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 (OR[95%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.

Publication Date

3-2026

Disciplines

Critical Care | Pediatrics

When and Where Presented

Presented at the 2026 Critical Care Congress; Chicago, IL; March 22-24, 2026.

EEG Features And Rotterdam Head CT Score Predict Early Favorable Outcome In Pediatric Severe TBI

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