Mortality in children with severe head trauma: predictive factors and proposal for a new predictive scale.
BACKGROUND
Traumatic brain injury is a public health problem around the world, and recognition of systemic sources of secondary brain lesions is crucial to improve outcome.


OBJECTIVE
To identify the main predictors of mortality and to propose a grading scale to measure the risk of death.


METHODS
This retrospective study was based on medical records of children with severe traumatic brain injury who were hospitalized at a level I pediatric trauma center between January 2000 and December 2005. Multiple logistic regression analysis was done to identify independent factors related to mortality. A receiver-operating characteristics curve was performed to verify the accuracy of the multiple logistic regression, and associations that increased mortality were verified.


RESULTS
We identified 315 children with severe head injury. Median Glasgow Coma Scale score was 6, and median Pediatric Trauma Score was 4. Global mortality rate was 30%, and deaths occurred despite adequate medical management within the first 48 hours in 79% of the patients. Age<2 years (P=.02), Glasgow Coma Scale≤5 (P<10), accidental hypothermia (P=.0002), hyperglycemia (P=.0003), and coagulation disorders (P=.02) were all independent factors predicting mortality. A prognostic scale ranging from 0 to 6 that included these independent factors was then calculated for each patient and resulted in mortality rates ranging from 1% with a score of 6 to 100% with a score of 0.


CONCLUSIONS
Independent and modifiable mortality predictors could be identified and used for a new grading scale correlated with the risk of mortality in pediatric traumatic brain injury.
Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France. robertotude@gmail.com
José Roberto
JR
Tude Melo
Federico
F
Di Rocco
Stéphane
S
Blanot
Jamary
J
Oliveira-Filho
Thomas
T
Roujeau
Christian
C
Sainte-Rose
Caroline
C
Duracher
Antonio
A
Vecchione
Philippe
P
Meyer
Michel
M
Zerah
D000293:Adolescent; D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome