title: Outcome analysis and outcome predictors of traumatic head injury in childhood: Analysis of 454 observations.
abstract: OBJECTIVE
  To determine factors associated with poor outcome in children suffering traumatic head injury (HI).
  
  
  METHODS
  A retrospective study over an 8-year period including 454 children with traumatic HI admitted in the Intensive Care Unit of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during the ICU stay. Prognosis was defined according Glasgow outcome scale (GOS) performed after hospital discharge by ICU and pediatric physicians.
  
  
  RESULTS
  There were 313 male (68.9%) and 141 female patients. Mean age (±SD) was 7.2±3.8 years, the main cause of trauma was traffic accidents (69.4%). Mean Glasgow coma scale (GCS) score was 8±3, mean injury severity score (ISS) was 26.4±8.6, mean pediatric trauma score (PTS) was 4±2 and mean pediatric risk of mortality (PRISM) was 11.1±8. The GOS performed within a mean delay of 7 months after hospital discharge was as follow: 82 deaths (18.3%), 5 vegetative states (1.1%), 15 severe disabilities (3.3%), 71 moderate disabilities (15.6%) and 281 good recoveries (61.9%). Multivariate analysis showed that factors associated with poor outcome (death, vegetative state or severe disability) were: PRISM ≥24 (P=0.03; OR: 5.75); GCS ≤8 (P=0.04; OR:2.42); Cerebral edema (P=0.03; OR:2.23); lesion type VI according to Traumatic Coma Data Bank Classification (P=0.002; OR:55.95); Hypoxemia (P=0.02; OR:2.97) and sodium level >145 mmol/l (P=0.04; OR: 4.41).
  
  
  CONCLUSIONS
  A significant proportion of children admitted with HI were found to have moderate disability at follow-up. We think that improving prehospital care, establishing trauma centers and making efforts to prevent motor vehicle crashes should improve the prognosis of HI in children.
authors.affiliation: Department of Intensive Care, Habib Bourguiba University hospital Sfax, Tunisia.
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.forename: Anis
authors.initials: A
authors.lastname: Chaari
authors.forename: Imen
authors.initials: I
authors.lastname: Chabchoub
authors.forename: Fatma
authors.initials: F
authors.lastname: Medhyoub
authors.forename: Hassen
authors.initials: H
authors.lastname: Dammak
authors.forename: Hatem
authors.initials: H
authors.lastname: Kallel
authors.forename: Hichem
authors.initials: H
authors.lastname: Ksibi
authors.forename: Sondes
authors.initials: S
authors.lastname: Haddar
authors.forename: Noureddine
authors.initials: N
authors.lastname: Rekik
authors.forename: Hedi
authors.initials: H
authors.lastname: Chelly
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz