Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries.
OBJECTIVE
To analyze factors associated with intracranial hypertension in pediatric patients who suffered severe head injuries.


METHODS
Retrospective cohort study, with data collected from September 1998 through August 2003, including patients aged 0 to 16 who suffered severe head injuries, Glasgow score < 9, and submitted to intracranial pressure (ICP) monitoring (n = 132). Intracranial hypertension (IH) was defined as an episode of ICP > 20 mmHg requiring treatment, while refractory IH was ICP over 25 mmHg requiring barbiturates or decompressive craniectomy. Univariate analysis was followed by multivariate analysis; variables were considered significant if p < 0.05.


RESULTS
Ages ranged from 2 months to 16 years, median age 9.7 (6.0-2.3) years. Glasgow scores ranged from 3 to 8, median 6 (4-7). Traffic accidents were responsible for 79.5% of events. Monitoring devices were installed, on average, 14 hours after trauma, median time 24 hours. One hundred and three patients (78%) had IH, while 57 (43.2%) had refractory IH. In multivariate analysis, younger age ranges were associated with IH [relative risk = 1.67 (1.03-2.72); p = 0.037], and abnormal postures were associated with refractory IH [relative risk = 2.25 (1.06-4.78)]. The group mortality rate was 51.5%; it was correlated with use of barbiturates in refractory IH and low cerebral perfusion pressure at the intensive care unit.


CONCLUSIONS
IH and refractory IH were frequent events in pediatric patients who suffered severe head injuries. The younger the patient, the greater the chance of developing IH. The presence of abnormal postures was found to be a risk factor for refractory IH.
Guerra
Sérgio Diniz
SD
Ciências da Saúde, Saúde da Criança e do Adolescente, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. dinizguerra@gmail.com.br
Carvalho
Luis Fernando Andrade
LF
Affonseca
Carolina Araújo
CA
Ferreira
Alexandre Rodrigues
AR
Freire
Heliane Brant Machado
HB
D000293:Adolescent; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000503:physiopathology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D011187:Posture / Q000502:physiology