Severe head injury among children: computed tomography evaluation as a prognostic factor.
BACKGROUND
The value of neuroimaging in predicting unfavorable events in the outcome of pediatric patients has not been established. Our objectives were to determine clinical characteristics and outcome of severely head-injured children admitted to the pediatric intensive care unit (PICU) of a pediatric third-level university hospital and to evaluate the use of neuroimaging as a prognostic factor of morbimortality in these patients.


METHODS
We performed a 9-year retrospective review. We included all patients with severe head injury admitted to the pediatric intensive care unit of our hospital from January 1995 to December 2003 requiring invasive intracranial pressure monitoring. Clinical summaries and imaging studies were reviewed.


RESULTS
Data for 156 pediatric patients, aged 1 to 18 years, were collected. We reclassified neuroimaging patterns into 2 groups: those with few imaging findings and those with important lesions. These 2 groups were significantly correlated with initial Glasgow Coma Scale (P < .05). We classified patients into favorable evolution, moderate disability, and unfavorable evolution. Poorer evolution correlated with poorer initial neuroimaging patterns, and these differences were statistically significant (P < .05).


CONCLUSIONS
In our group of patients, initial Glasgow Coma Scale was related with the initial neuroimaging pattern, and this relation was statistically significant. Findings in the first and second neuroimaging were useful as prognostic factors in our series.
Claret Teruel
Gemma
G
Paediatrics Department, Integrated Unit Sant Joan de Déu-Clínic, Hospital Universitari Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues (Barcelona), Spain. gclaret@hsjdbcn.org
Palomeque Rico
Antonio
A
Cambra Lasaosa
Francisco José
FJ
Català Temprano
Albert
A
Noguera Julian
Antoni
A
Costa Clarà
Josep Maria
JM
D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D015278:Intensive Care Units, Pediatric; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*