Head trauma in children, part 2: course and discharge with outcome.
To minimize the secondary brain damage, we analyzed the effect of cerebral perfusion pressure-orientated management and tried to find factors of clinical management and biochemical findings that influence clinical, cognitive, and psychosocial outcome. Management at intensive care unit was standardized. A standardized (short form 36 health survey) and nonstandardized split questionnaire explored long-term outcome. Glutamic-oxaloacetic-transaminase, creatine kinase MB or glucose are markers for bad outcome (P < .05). Patients with cerebral perfusion pressure values below the recommended standard for just a single occurrence had significantly worse outcome (P = .0132). Mean arterial pressure, central venous pressure, and heart rate alone do not correlate with outcome. At least 1 occurrence of mean arterial pressure and central venous pressure below the lower limits resulted in a poor outcome (P = .035). Cerebral perfusion pressure-guided therapy seems to prevent further brain damage and results in outcome scores that are comparable to those children with head trauma exhibiting symptoms of mild brain edema.
Kapapa
Thomas
T
Department of Neurosurgery, University of Ulm, Ulm, Germany. Thomas.Kapapa@uniklinik-ulm.de
König
Kathrin
K
Pfister
Ulrike
U
Sasse
Michael
M
Woischneck
Dieter
D
Heissler
Hans
H
Rickels
Eckhard
E
D000293:Adolescent; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001930:Brain Injuries / Q000097:blood / Q000517:prevention & control / Q000601:surgery; D002404:Catheterization; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005947:Glucose / Q000378:metabolism; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D052279:Creatine Kinase, MB Form; D005947:Glucose