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Management and outcome of severe head injuries in the Trent region 1985-90
A C Elias-Jones1, J A Punt, A E Turnbull
1Department of Child Health, Queen's Medical Centre, University Hospital, Nottingham.
Insights
Severe hypocapnia and low cerebral perfusion pressure are linked to poor outcomes in pediatric major head injuries. These factors, along with specific injury types, indicate a worse prognosis for affected children.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Child neurology
Background:
- Major head injuries in children are a significant cause of mortality and long-term disability.
- Understanding prognostic factors is crucial for optimizing treatment strategies in pediatric neurotrauma.
Purpose of the Study:
- To investigate the relationship between physiological parameters, injury characteristics, and outcomes in children with severe head injuries.
- To identify key indicators of poor prognosis in pediatric head trauma patients.
Main Methods:
- A retrospective study of 39 children (2 months to 13 years) with major head injuries.
- Clinical assessment, neuroimaging (CT/ultrasound), and monitoring of Glasgow Coma Scale (GCS), intracranial pressure (ICP), and cerebral perfusion pressure (CPP).
- Treatment included sedation, paralysis, hyperventilation, ICP monitoring, and moderate hypothermia.
Main Results:
- Nine out of 39 children died; 30 survived with varying degrees of disability.
- Lower cerebral perfusion pressure (<40 mm Hg) was associated with fatalities.
- Severe hypocapnia (low arterial carbon dioxide tension) within the first 24 hours and overall correlated with poor outcomes (death or major disability).
- Bilateral contusions and diffuse axonal injury were also linked to adverse outcomes.
Conclusions:
- Cerebral perfusion pressure below 40 mm Hg is a critical indicator of poor prognosis in pediatric head injury.
- Severe hypocapnia is a significant predictor of mortality and major disability in this population.
- Early identification of these physiological derangements and injury patterns can guide aggressive management in pediatric neurocritical care.
Abstract:
In a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7.8 years) were studied who had suffered a major head injury (29 road traffic accidents, six falls, and four non-accidental injury). The injury had been assessed clinically and by cranial computed tomography or cranial ultrasound (in a single baby of 2 months). Initial Glasgow coma scores for all subjects ranged from 3-11 (mean 5.5), intact survivors 5-11 (7.4), minor handicap 4-11 (6.1), major handicap 3-6 (4.3), fatalities 3-6 (4.1). All were treated with sedation, paralysis, hyperventilation (arterial carbon dioxide tension 3.0-3.5 kPa), intracranial pressure monitoring and moderate body surface hypothermia to 32 degrees C. Nine children died and 30 survived (nine intact, 13 minor disability, and eight major disability). The worst cerebral perfusion pressure was over 40 mm Hg in all but one survivor, and less than 40 mm Hg in seven of nine fatalities. Severe hypocapnia both in the first 24 hours and overall was correlated with poor outcomes (dead or major disability), as were bilateral contusions or diffuse axonal injury.