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Severe head injury among children: prognostic factors and outcome
Mabrouk Bahloul1, Chokri Ben Hamida, Hedi Chelly
1Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia. bahloulmab@yahoo.fr
Insights
Predictive factors for mortality in children with severe traumatic brain injury were identified. High Injury Severity Score (ISS) and Paediatric Risk of Mortality (PRISM) scores, along with bilateral mydriasis, indicated a poor prognosis.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Public Health
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality and morbidity in children.
- Understanding predictive factors for mortality is crucial for improving outcomes in pediatric TBI cases.
- Road traffic accidents are a leading cause of TBI in children, particularly in regions like Tunisia.
Purpose of the Study:
- To identify demographic, clinical, biological, and radiological factors that predict mortality in children with severe head injuries.
- To analyze the short-term prognosis of pediatric TBI in a Tunisian university hospital setting.
Main Methods:
- A retrospective study involving 222 children with severe head injury (Glasgow Coma Scale score ≤ 8) over 8 years.
- Data collected included basic demographics, clinical status, biological markers, and radiological findings on admission and during ICU stay.
- Statistical analyses included univariate and multivariate approaches to determine significant predictors of mortality.
Main Results:
- The study included 222 children (73.4% boys), with a mean age of 7.54 years. Road traffic accidents accounted for 75.7% of cases.
- Overall mortality rate was 24.3%. Factors associated with mortality in univariate analysis included low Paediatric Trauma Score (PTS), high Injury Severity Score (ISS) or Paediatric Risk of Mortality (PRISM), shock, meningeal hemorrhage, bilateral mydriasis, and elevated serum glucose (> 10 mmol/L).
- Multivariate analysis identified PRISM > 20 and bilateral mydriasis on admission as independent predictors of poor prognosis.
Conclusions:
- Head injury, primarily from road traffic accidents, is a frequent cause of hospital admission for children in Tunisia.
- The short-term prognosis for pediatric TBI is poor, with a significant mortality rate.
- Mortality is influenced by a combination of demographic, clinical, radiological, and biological factors, highlighting the need for targeted interventions.
Aim:
To determine predictive factors of mortality among children after traumatic brain injury.
Methods:
A retrospective study over 8 years of 222 children with severe head injury (Glasgow Coma Scale score < or = 8) admitted to a university hospital (Sfax, Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during intensive care unit stay.
Results:
The study included 163 boys (73.4%) and 59 girls, with mean age 7.54+/-3.8 years. The main cause of trauma was road traffic accident (75.7%). Mean Glasgow Coma Scale score was 6+/-1.5, mean Injury Severity Score (ISS) was 28.2+/-6.9, mean Paediatric Trauma Score (PTS) was 3.7+/-2.1 and mean Paediatric Risk of Mortality (PRISM) was 14.3+/-8.5; 54 children (24.3%) died. Univariate analysis showed that low PTS on admission, high ISS or PRISM, presence of shock or meningeal haemorrhage or bilateral mydriasis, and serum glucose > 10 mmol l(-1) were associated with mortality rate. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 20 and bilateral mydriasis on admission.
Conclusions:
In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic accidents. Short-term prognosis is poor, with a high mortality rate (24.3%), and is influenced by demographic, clinical, radiological and biological factors.
