Prognostic factors and outcome of children with severe head injury: an 8-year experience.
OBJECTIVE
Our aim was to analyze prognostic factors and their association with outcome among children with severe head injury.


METHODS
We conducted a retrospective study among children with severe head injury admitted to our Pediatric Intensive Care Unit (PICU) from November 1992 to December 2000. The patients were immediately evaluated for the severity of head injury (Glasgow Coma Score, GCS), clinical presentation, cerebral axial tomography, early complications (hypoxia and hypotension), metabolic and hematological alterations and early post-traumatic seizures. Six months after injury we applied the Glasgow Outcome Score (GOS). Correlations with GOS were evaluated using univariate and multivariate logistic models.


RESULTS
In all, 122 children with severe head injury were identified. The patients presented the following scores: 18 (14.7.0%) children had a GOS of 1; 2 had a GOS of 2 (1.6%); 27 (22.2%) a GOS of 3 and 75 (61.5%) a GOS of 4 or 5. A low GOS was significantly and independently associated with low GCS, multiple trauma, the presence of hypoxia and hypotension, disseminated intravascular coagulation (DIC), hyperglycemia and early post-traumatic seizures. Hematological alterations (white blood cells) were also associated with a low GOS, though not significantly.


CONCLUSIONS
In addition to GCS, types of trauma and brain lesion, hypoxia and hypotension, hemocoagulative disorders (DIC), hyperglycemia and early post-traumatic seizures are predictors of GOS. A knowledge of these prognostic factors and the correct management of children with severe head injury helps clinicians to improve outcome and to reduce morbidity and mortality.
Chiaretti
Antonio
A
Pediatric Intensive Care Unit, Gemelli Hospital, Largo Gemelli, 00168 Rome, Italy. chiarant@katamail.com
Piastra
Marco
M
Pulitanò
Silvia
S
Pietrini
Domenico
D
De Rosa
Gabriella
G
Barbaro
Roberta
R
Di Rocco
Concezio
C
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000503:physiopathology*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D008297:Male; D009104:Multiple Trauma / Q000503:physiopathology; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index