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Prognostic factors in children with severe diffuse brain injuries: a study of 74 patients
S Pillai1, S S Praharaj, A Mohanty
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
Insights
Predicting outcomes in pediatric severe diffuse brain injury is crucial. The Glasgow Coma Scale (GCS) and oculocephalic reflex are key indicators for unfavorable outcomes in children with severe brain injuries.
Area of Science:
- Pediatric Neurology
- Neurotrauma Research
- Clinical Outcomes Analysis
Background:
- Severe diffuse brain injury significantly impacts children's physical and psychological development.
- Identifying prognostic factors is essential for managing pediatric traumatic brain injuries.
- Previous research highlights the need for reliable outcome predictors in pediatric neurotrauma.
Purpose of the Study:
- To analyze factors influencing short-term outcomes in children with severe diffuse brain injury.
- To identify independent predictors of poor prognosis in pediatric traumatic brain injury.
- To evaluate the prognostic significance of clinical and CT scan findings.
Main Methods:
- Retrospective analysis of 74 children (age <=15 years) with severe diffuse brain injury.
- Inclusion criteria: no focal operable mass lesions on CT scan.
- Prognostic factors analyzed: age, gender, time to admission, injury nature, Glasgow Coma Score (GCS), pupillary reaction, oculocephalic reflex, and CT findings.
Main Results:
- Independent predictors of poor outcome included low GCS (3-5), absent verbal/motor response, absent pupillary reaction, absent oculocephalic reflex, and traumatic subarachnoid hemorrhage.
- Stepwise logistic regression identified oculocephalic reflex and GCS as the most important predictors.
- These two factors predicted unfavorable outcomes with 79% sensitivity and 65% specificity.
Conclusions:
- Oculocephalic reflex and GCS are critical for predicting outcomes in pediatric severe diffuse brain injury.
- Early or single CT scans showed no significant prognostic value.
- Accurate prediction of outcomes aids in clinical management and patient care planning for pediatric neurotrauma.
Abstract:
Severe diffuse brain injury in children has a devastating influence on their physical and psychological development. This retrospective study was undertaken to analyse the factors that influence outcome in children with such injuries. The short-term outcomes (Glasgow outcome score) of 74 children (age < or =15 years) with severe diffuse brain injury and no focal operable mass lesions on CT scan, admitted between 1992 and 1998 at the National Institute of Mental Health and Neurosciences were analysed. The prognostic factors analysed were age, gender, time after injury to admission, nature of injury, highest post-resuscitation Glasgow coma score (GCS), pupillary reaction, horizontal oculocephalic reflex and CT scan findings. The following factors were found to be independent predictors of poor outcome: GCS 3-5 (p < 0.003), absent verbal response (p < 0.001), motor response score of 1-3 (p < 0.001), absent pupillary reaction (p < 0.001), absent oculocephalic reflex (p < 0.001) and presence of traumatic subarachnoid haemorrhage on CT scan (p < 0.002). These independent variables were then subjected to a stepwise logistic regression analysis, and the most important variables for predicting outcome were oculocephalic reflex and GCS, which together correctly predicted unfavourable outcome with a sensitivity of 79% and a specificity of 65%. An early CT scan or a single CT scan did not have any prognostic significance.