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[The management of the child with head injury: our experience]
A Chiaretti1, S Pulitanò, R De Benedictis
1Sezione Autonoma di Terapia Intensiva Pediatrica, Università Cattolica del Sacro Cuore, Roma. chiarant@katamail.com
Insights
Effective management of pediatric head injuries in the Pediatric Intensive Care Unit (PICU) significantly improves outcomes. Our therapeutic algorithms can guide clinicians in treating both severe and mild pediatric head injuries, reducing mortality.
Area of Science:
- Pediatric Intensive Care
- Neurotrauma Management
- Pediatric Head Injury
Context:
- Analysis of neurotrauma cases in a Pediatric Intensive Care Unit (PICU) from 1992 to 2000.
- Focus on pediatric head injury management and outcomes.
Purpose:
- To analyze pediatric neurotrauma admissions to the PICU.
- To describe management algorithms for pediatric head injury.
Summary:
- 210 children with head injuries were analyzed (38 mild, 50 moderate, 122 severe).
- Car accidents and falls were common causes.
- Good outcomes (GOS 4-5) were observed in mild/moderate injuries. Severe injuries had varied outcomes: 14.7% mortality, 1.6% persistent vegetative state, 22.2% severe disability, and 61.5% mild disability or no disability.
Impact:
- Proper management of pediatric head injuries improves patient outcomes.
- Developed therapeutic algorithms can aid clinicians in treating diverse head injury severities.
- Algorithms are beneficial for both severe and common mild head injuries encountered in emergency departments.
Objectives:
To analyze the group of children admitted to our Pediatric Intensive Care Unit (PICU) for neurotrauma and describe the management algorithms adopted by us for pediatric head injury.
Methods:
All the children affected by head injury and admitted to PICU since november 1992 to november 2000 have been examined. Injury severity has been classified using the Glasgow Coma Score (GCS), while the long term neurological outcome with the Glasgow Outcome Score (GOS). We have described the clinical presentation, the kind and dynamics of injury and the clinical outcome one month after discharge.
Results:
210 children with head injury have been identified. Among them: 38 were affected by mild head injury, 50 by a moderate one and 122 by a severe one. The most frequent cause of injury has been represented by car accidents and motorbike or bicycle falls. The overall outcome has resulted good (GOS 4-5) in all children affected by mild or moderate head injury; on the other side, patients with severe injury have presented the following scores: GOS 1 (dead children) 14.7%, GOS 2 (persistent vegetative state) 1.6%, GOS 3 (severe disability) 22.2%, GOS 4 (mild disability) and GOS 5 (no disability) 61.5%.
Conclusion:
A correct management of children with head injury helps clinicians to improve outcome and to reduce mortality. Therapeutics algorithms suggested by us could be useful for the management of this kind of patients, not only when they are affected by a severe head injury but, also, when they suffer from a mild one, that is the most common event in the emergency room departments.
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