Severe head injury among children: prognostic factors and outcome.
OBJECTIVE
To determine predictive factors of mortality among children after traumatic brain injury.


METHODS
A retrospective study over 8 years of 222 children with severe head injury (Glasgow Coma Scale score < or = 8) admitted to a university hospital (Sfax, Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during intensive care unit stay.


RESULTS
The study included 163 boys (73.4%) and 59 girls, with mean age 7.54+/-3.8 years. The main cause of trauma was road traffic accident (75.7%). Mean Glasgow Coma Scale score was 6+/-1.5, mean Injury Severity Score (ISS) was 28.2+/-6.9, mean Paediatric Trauma Score (PTS) was 3.7+/-2.1 and mean Paediatric Risk of Mortality (PRISM) was 14.3+/-8.5; 54 children (24.3%) died. Univariate analysis showed that low PTS on admission, high ISS or PRISM, presence of shock or meningeal haemorrhage or bilateral mydriasis, and serum glucose > 10 mmol l(-1) were associated with mortality rate. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 20 and bilateral mydriasis on admission.


CONCLUSIONS
In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic accidents. Short-term prognosis is poor, with a high mortality rate (24.3%), and is influenced by demographic, clinical, radiological and biological factors.
Bahloul
Mabrouk
M
Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia. bahloulmab@yahoo.fr
Ben Hamida
Chokri
C
Chelly
Hedi
H
Chaari
Adel
A
Kallel
Hatem
H
Dammak
Hassen
H
Rekik
Noureddine
N
Bahloul
Kamel
K
Ben Mahfoudh
Kheireddine
K
Hachicha
Mongia
M
Bouaziz
Mounir
M
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D001930:Brain Injuries / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000401:mortality / Q000628:therapy; D003422:Critical Care; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D009333:Neck / Q000000981:diagnostic imaging; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014416:Tunisia / Q000453:epidemiology