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Prognosis in children with head injury: an analysis of 340 patients
H S Suresh1, S S Praharaj, B Indira Devi
1Department of Neurosurgery, NIMHANS, Bangalore-560029, India.
Insights
Pediatric head injuries have unique outcomes due to developing physiology. Key poor prognostic indicators include abnormal pupillary response and young age, impacting long-term results.
Area of Science:
- Pediatric Traumatology
- Pediatric Neurology
- Neurocritical Care
Background:
- Child head injury outcomes differ due to unique skull and brain biophysical properties.
- Pediatric head trauma management requires specialized consideration.
Purpose of the Study:
- To analyze factors influencing outcomes in children with head injuries.
- To evaluate prognosis in various intracranial pathologies following head trauma.
Main Methods:
- Retrospective study of 340 children with head injury.
- Data collected from January 1993 to December 1998 at NIMHANS.
- Outcome assessment at discharge based on Glasgow Coma Scale (GCS) and intracranial pathology.
Main Results:
- Poor outcomes were observed in 8.4% of Epidural Hematoma (EDH) cases and 18.8% of contusion cases.
- Diffuse cerebral edema showed a 25% poor outcome rate.
- Clinical predictors of poor prognosis included absent ocular movements (50%), abnormal pupillary size/reaction (49%), and age under 2 years (27%).
Conclusions:
- Age, pupillary response, and ocular movements are critical prognostic factors in pediatric head injury.
- Specific intracranial pathologies like diffuse cerebral edema are associated with higher rates of poor outcomes.
- Early identification of these factors can guide management and improve patient outcomes.
Background:
The outcome in children with head injury is distinctive because of the different biophysical properties of the child's skull and brain, and their reaction to injury.
Methods:
In this retrospective study of three hundred and forty children with head injury, managed from January 1993 to December 1998, at NIMHANS, the factors influencing outcome were analyzed.
Results:
On admission there were 40 children in GCS 3-5, 55 children in GCS 6-8, 96 in GCS 9-12 and 152 children in GCS 13-15. Eleven patients were under 2 years of age, 53 were between 3-5 years, 140 were between 6-10 years and 156 were between 11-15 years of age. The prognosis in various intracranial pathologies due to head injury was evaluated and outcome assessed at discharge. There were 95 children with EDH and 8.4% had poor outcome (vegetative state or death). There were 85 patients with contusion and poor outcome was noted in 18.8%. One hundred patients had diffuse cerebral oedema on CT scan and outcome was poor in 25% of these patients. The clinical features associated with poor prognosis were, absence of ocular movements (50%), abnormal pupillary size and reaction (49%) and age less than 2 years (27%).