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Childhood head injury: causes, outcome, and outcome predictors. A Nigerian perspective
1odebodetodr@yahoo.com
Insights
Head injury in children often results in good outcomes with nonoperative management. Patient age and initial coma score are key predictors of recovery in pediatric head injury cases.
Area of Science:
- Pediatric Traumatology
- Neurotrauma Research
- Public Health Epidemiology
Background:
- Head injury is a leading cause of pediatric trauma mortality globally.
- Nonoperative management of pediatric head injury was standard practice at the center until 2000.
- Understanding outcomes and predictors is crucial for improving pediatric head injury care.
Purpose of the Study:
- To evaluate outcomes in children with head injuries managed nonoperatively.
- To identify predictors of outcome in pediatric head injury patients.
- To analyze data from a 10-year retrospective study in Ilorin, Nigeria.
Main Methods:
- Retrospective analysis of 267 pediatric head injury cases (1989-1999).
- Outcome assessment using Glasgow Outcome Scale.
- Linear regression analysis to test clinical variables (age, gender, Glasgow Coma Score) against outcome.
Main Results:
- Road traffic accidents (64.1%) and falls (30.7%) were primary causes.
- Head injuries were isolated in 60% of cases.
- Good outcomes were observed in 77.5% of children; mortality was 14.2%.
- Age (p=0.0206) and postresuscitation Glasgow Coma Score (p=0.0000) significantly predicted outcome.
- Gender was not a significant predictor (p=0.3043).
Conclusions:
- Nonoperative management yields favorable outcomes in over 75% of pediatric head injury cases.
- Patient age and initial Glasgow Coma Score are critical for predicting recovery.
- Findings highlight the importance of early assessment and age/coma score in pediatric head trauma management.
Abstract:
Head injury is the most common cause of death following trauma among children in most developed and underdeveloped countries. Management of the head-injured child remained conservative in the hands of the general and orthopedic surgeons until October 2000 in our center. To determine outcome and outcome-predictors in children managed nonoperatively for head injury in Ilorin, Nigeria, a 10-year retrospective study of children managed for head injury was done. Outcome was measured by Glasgow outcome scoring. Clinical variables including age, gender, and postresuscitation Glasgow coma score were tested against Glasgow outcome score by linear regression analysis. During the study period (1989-1999), 267 children (173 males and 94 females) aged 16 years and below with head injuries were admitted. Their injuries were due mostly to road traffic accidents (64.1%) and falls (30.7%). Other injuries were domestic, sport-related, or due to assaults or the fall of collapsed walls, water-pots, and coconut shells on victims' heads. Head injuries were isolated in 60% of patients but associated with skeletal, facial, and spinal injuries in 58, 18, and seven cases, respectively. They were mild in 100 (37.5%), moderate in 73 (27.3%), but severe in 94 (35.2%) cases. Outcome was good in 207 (77.5%) but fatal in 38 (14.2%) children. Only age (p=0.0206) and coma score (p=0.0000), but not gender (p= 0.3043), could predict outcome. Outcome was good in more than 75% of cases of head-injured children managed nonoperatively. It varied with the patient's age and postresuscitation Glasgow coma score.
