title: Mortality in Children With Severe Head Trauma: Predictive Factors and Proposal for a New Predictive Scale.
abstract: 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.
  
  
  
  To identify the main predictors of mortality and to propose a grading scale to measure the risk of death.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 1Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France; and Postgraduate Program in Medicine and Health, School of Medicine, Federal University of Bahia, Bahia, Brazil 2Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France 3Pediatric Surgical Critical Care Unit and Anesthesiology, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France 4Postgraduate Program in Medicine and Health, School of Medicine, Federal University of Bahia, Bahia, Brazil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Tude Melo
authors.forename: Federico Di
authors.initials: FD
authors.lastname: Rocco
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanot
authors.forename: Jamary
authors.initials: J
authors.lastname: Oliveira-Filho
authors.forename: Thomas
authors.initials: T
authors.lastname: Roujeau
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
authors.forename: Caroline
authors.initials: C
authors.lastname: Duracher
authors.forename: Antonio
authors.initials: A
authors.lastname: Vecchione
authors.forename: Philippe
authors.initials: P
authors.lastname: Meyer
authors.forename: Michel
authors.initials: M
authors.lastname: Zerah
mesh_terms: D001930:Brain Injuries / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma; D015600:Glasgow Coma Scale; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome