title: Outcome following severe head injuries in children.
abstract: The outcome in 53 children following severe head injury is presented. All children were graded using the Glasgow Coma Scale; 90% made a good recovery or were moderately disabled, and 8% died or were left vegetative. All patients were treated with controlled ventilation and steroids; mannitol, and, if necessary, Nembutal (pentobarbital) were used to maintain the intracranial pressure below 20 torr. With this regimen, only one death occurred due to uncontrollable intracranial hypertension. All patients with a coma scale of 5 or greater recovered well. The worst prognostic sign was the presence of flaccidity: 33% of these patients died or were vegetative. Five of seven patients who were decerebrate or flaccid with bilateral fixed pupils and absent caloric responses made a good recovery or were moderately disabled. The relatively low incidence of mass lesions (23%) and high incidence of diffuse cerebral swelling (34%) suggest a different pathophysiological response of the child's brain to injury, which may play a role in the improved survival of children following severe head injury when compared to adults.
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D002648:Child; D003128:Coma / Q000175:diagnosis; D006801:Humans; D008722:Methods; D009460:Neurologic Examination; D011379:Prognosis; D013997:Time Factors