Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry.
BACKGROUND
In the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in-hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy.


METHODS
We performed a retrospective analysis of the TraumaRegister DGU(®) from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1-3, 4-6, 7-10, 11-14, 15-17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ failure, and mortality. Additionally, the Glasgow Outcome Scale (GOS) at discharge was observed.


RESULTS
Overall, 1110 children and 6491 adult control patients were included. Comparing the rate of intubation on-scene, the rate of cranial CT scans, the rate of craniotomies, and the rate and length of intensive care treatment, we could only identify minor differences between the age groups. The treatment after discharge from hospital was markedly different due to a very low rate of in-patient rehabilitation treatment in children. On one hand, the rate of systemic complications, such as sepsis and multiple organ failure increased with increasing age. On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury. The in-hospital functional outcome in survivors, according to the GOS, was beneficial for younger children in comparison to adolescents and adults.


CONCLUSIONS
We were unable to identify marked age-related differences in the therapeutic approach. Nevertheless, we were able to demonstrate marked differences of outcome. Children younger than 7 years significantly die more often due to direct impact of severe trauma. But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. plichte@ukaachen.de.
Philipp
P
Lichte
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. handruszkow@ukaachen.de.
Hagen
H
Andruszkow
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. Miriam.Kappe@rwth-aachen.de.
Miriam
M
Kappe
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. khorst@ukaachen.de.|Harald Tscherne Research Laboratory for Orthopedic Trauma, Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Aachen, Germany. khorst@ukaachen.de.
Klemens
K
Horst
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. mpishnamaz@ukaachen.de.|Harald Tscherne Research Laboratory for Orthopedic Trauma, Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen, Aachen, Germany. mpishnamaz@ukaachen.de.
Miguel
M
Pishnamaz
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. fhildebrand@ukaachen.de.
Frank
F
Hildebrand
Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. Rolf.Lefering@uni-wh.de.
Rolf
R
Lefering
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. hpape@ukaachen.de.
Hans-Christoph
HC
Pape
Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. pkobbe@ukaachen.de.
Philipp
P
Kobbe
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult