Cushing's sign and severe traumatic brain injury in children after blunt trauma: A nationwide retrospective cohort study in Japan

Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Hiroki Maeyama, Yoshinori Kosaki, Hirotsugu Yamamoto, Kohei Tsukahara, Takaaki Osako, Atsunori Nakao

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Objective We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. Design Retrospective cohort study using Japan Trauma Data Bank. Setting Emergency and critical care centres in secondary and tertiary hospitals in Japan. Participants 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. Primary outcome measures Patients requiring neurosurgical intervention within 24 hours 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. Results 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 ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<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 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. Conclusions Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-Age children and young adolescents.

Original languageEnglish
Article numbere020781
JournalBMJ Open
Issue number3
Publication statusPublished - Mar 1 2018


  • paediatric neurology
  • paediatric neurosurgery

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Cushing's sign and severe traumatic brain injury in children after blunt trauma: A nationwide retrospective cohort study in Japan'. Together they form a unique fingerprint.

Cite this