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Published on: January 20, 2023
[Prognostic risk factors in children and adolescents with craniocerebral injuries with multiple trauma]
H Rupprecht1, A Mechlin, D Ditterich
1Abteilung für Chirurgie, Klinikum Hof/Saale, Eppenreutherstrasse 9, 95032 Hof.
Insights
Head injuries significantly increase mortality in polytrauma patients. The Hannover Polytrauma Score shows brain injury severity impacts prognosis, with skull fractures and shock being critical risk factors.
Area of Science:
- Trauma Surgery
- Neurological Surgery
- Emergency Medicine
Context:
- Polytrauma patients frequently sustain head injuries, significantly impacting survival rates.
- The Hannover Polytrauma Score is utilized to assess trauma severity and patient prognosis.
- Head injuries are a critical factor in the mortality of polytraumatized individuals.
Purpose:
- To investigate the correlation between head injuries and mortality in polytraumatized patients.
- To evaluate the prognostic value of the Hannover Polytrauma Score concerning brain injury severity.
- To identify key risk factors, such as skull fractures and shock, influencing outcomes.
Summary:
- 82.1% of polytraumatized patients had associated head injuries, leading to significantly higher mortality.
- The extent of brain injury, assessed by the Hannover Polytrauma Score, directly correlates with polytrauma severity and prognosis.
- Skull fractures and shock on arrival are identified as critical risk factors, with mortality rates of 66.7% for severe brain trauma with fractures versus 36.8% without.
- In pediatric polytrauma, survival rates are markedly higher with a systolic blood pressure (SBP) > 80 mm Hg (76.1%) compared to SBP ≤ 80 mm Hg (31.2% survival).
Impact:
- Recommends head computed tomography (CT) for all polytraumatized children.
- Suggests follow-up cranial CT (CCT) even if the initial CT is negative, to detect delayed neurological complications.
- Highlights the importance of early and comprehensive head injury assessment in polytrauma management.
Abstract:
220 of 268 polytraumatized patients (82.1%) presented an additional head injury, which increased the mortality significantly. By the Hannover Polytrauma Score we could demonstrate that the severity of the polytrauma and the prognosis depended on the extent of the brain injury. Important risk factors were skull fractures and shock on arrival. 66.7% of the patients with a severe brain trauma and a skull fracture died; without this fracture, only 36.8% died. 76.1% of the children with a systolic blood pressure (SBP) > 80 mm Hg survived, but only 31.2% with a SBF < or = 80 mm Hg did not die. For all polytraumatized children we recommend a computer tomography of the head. In spite of a negative initial CT a follow up CCT should be performed.
