Critical care management of severe head injury in children.
BACKGROUND
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 (n=55) with severe head injury [Glasgow Coma Score (GCS) ?8] who were admitted to our Neurosurgical Intensive Care Unit (ICU) from January 1996 to September 2003. The patients were immediately evaluated with cranial computed tomography (CT) for the severity of head injury as well as for the causes of secondary insults such as hypoxia and hypotension, metabolic and hematological alterations. Outcome analysis was assessed according to Glasgow Outcome Scale Score (GOS) six months after the injury.


RESULTS
A poor result occurred in 31 patients (57%) while 24 patients (43%) had favourable results. Multivariate analysis showed significant independent prognostic effect for admission mean systolic blood pressure, presence of hypoxia, multiple trauma, admission GCS score and multiple intracranial lesions (p<0.05). Admission WBC counts and serum glucose levels were not correlated with GOS.


CONCLUSIONS
This study describes clinicoradiologic findings and prognostic factors regarding severe head injury in pediatric patients. The goals of managements of pediatric patients with severe traumatic head injury include normalizing intracranial pressure, optimizing arterial blood gases and systemic blood pressure, and prevention of factors that exacerbate secondary brain injury.
Şahin
Soner
S
Department of Neurosurgery, Uludağ University School of Medicine, Görükle, Bursa, Turkey.
Bekar
Ahmet
A
Doğan
Şeref
Ş
Kocaeli
Hasan
H
Aksoy
Kaya
K
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed