title: Intensive care for pediatric traumatic brain injury.
abstract: OBJECTIVE
  The aims of this study are to describe a cohort of head-injured pediatric patients, focusing on current practice for intracranial pressure (ICP) monitoring and treatment and to verify the relationship between clinical and radiological parameters and the six-month outcome in a multivariable statistical model.
  
  
  METHODS
  A retrospective review was done of a prospectively collected database considering patients younger than 19 years admitted to three neuro-intensive care units (ICU). Patients were divided into four age groups: 0-5 (infant), 6-12 (children), 13-16 (pre-adolescent) and 17-18 years (adolescent). The ICP and cerebral perfusion pressure (CPP) were analyzed calculating average data and values exceeding thresholds for more than 5 min. Outcome was assessed 6 months after trauma using the Glasgow Outcome Score.
  
  
  RESULTS
  There were 199 patients, 155 male, included. Sixty percent had extracranial injuries. Pupils were abnormal in 38 %. Emergency evacuation of intracranial hematomas was necessary in 81 cases. The ICP was monitored in 117 patients; in 87 cases ICP was higher than 20 mmHg, with no differences among age groups. All but six patients received therapy to prevent raised ICP; barbiturates, deep hyperventilation or surgical decompression were used in 31 cases. At 6 months, mortality was 21 % and favorable outcome was achieved by 72 %. Significant predictors of outcome in the multivariable model were the Glasgow Coma Scale (GCS) motor score, pupils and ICP.
  
  
  CONCLUSIONS
  Pediatric head injury is associated with a high incidence of intracranial hypertension. Early surgical treatment and intensive care may achieve favorable outcome in the majority of cases.
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Neurointensive Care Unit and University of Milan, Milan, Italy. anna.sigurta@unimi.it
authors.forename: A
authors.initials: A
authors.lastname: Sigurtà
authors.forename: C
authors.initials: C
authors.lastname: Zanaboni
authors.forename: K
authors.initials: K
authors.lastname: Canavesi
authors.forename: G
authors.initials: G
authors.lastname: Citerio
authors.forename: L
authors.initials: L
authors.lastname: Beretta
authors.forename: N
authors.initials: N
authors.lastname: Stocchetti
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome