Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy--the Lund concept.
OBJECTIVE
This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved.


METHODS
A two-center retrospective study in neurointensive care units at university hospitals.


METHODS
Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h.


METHODS
Treatment according to the principles of the Lund concept.


RESULTS
Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations.


CONCLUSIONS
Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.
Wahlström
Marie Rodling
MR
Department of Anesthesia and Intensive Care, Umeå University Hospital, 90185 Umeå, Sweden. marie.rodling@anestesi.umu.se
Olivecrona
Magnus
M
Koskinen
Lars-Owe D
LO
Rydenhag
Bertil
B
Naredi
Silvana
S
D000293:Adolescent; D000465:Algorithms; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007427:Intracranial Pressure; D008297:Male; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*