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Defenestration in children younger than 6 years old: mortality predictors in severe head trauma
Jose Roberto Tude Melo1, Federico Di Rocco, Laudenor Pereira Lemos-Júnior
1Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris-France), Université Descartes Paris 5, Paris, France. robertotude@gmail.com
Insights
Severe head injuries in children under 6 from window falls have high mortality. Hypothermia, hyperglycemia, and coagulation disorders independently predict death in these pediatric trauma cases.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Injury Prevention
Background:
- Falls from windows are a significant cause of severe head injuries in young children.
- Understanding the characteristics and predictors of mortality is crucial for improving outcomes.
Purpose of the Study:
- To describe severe head injuries in children under 6 resulting from falls from windows.
- To identify independent predictors of mortality in this vulnerable pediatric population.
Main Methods:
- A cross-sectional study analyzed medical records of children (<6 years) with severe head injury (Glasgow Coma Scale [GCS] ≤8) from window falls.
- Data from January 2000 to December 2005 at a Level III Pediatric Trauma Center were used.
- Univariate and multiple logistic regression analyses were performed.
Main Results:
- 58 cases of severe head injury from window falls were identified; 41% mortality rate.
- Patients often presented with low GCS (≤5) and low Pediatric Trauma Score (PTS ≤3).
- Independent predictors of mortality included initial hypothermia, hyperglycemia, and coagulation disorders.
Conclusions:
- Severe head injuries from window falls pose a high mortality risk in young children.
- Hypothermia, hyperglycemia, and coagulation disorders are key independent predictors of death.
- Early mortality may result from severe, uncontrollable brain lesions.
Purpose:
This study aims to describe the characteristics of severe head injuries in children less than 6 years old, victims of falls from windows, and identify the main predictive factors of mortality in this population.
Patients And Methods:
A cross-sectional study was designed through data derived from medical records of less than 6-year-old children victims of falls from windows presenting with a severe head injury defined by an initial Glasgow coma scale (GCS) < or =8, hospitalized at a Pediatric Trauma center level III, between January 2000 and December 2005. Statistical analysis used univariate analysis and multiple logistic regressions.
Results:
We identified 58 severe head injuries in children victims of falls from windows. The mean age was 2.8 +/- 1.4 years, with a male prevalence (64%); 48% of patients had a GCS < or =5; 62.1% had a Pediatric Trauma Score (PTS) < or =3 at hospital admission. The mortality rate was 41% (24/58) and most of them (88%; 21/24) died within 48 h. An increased death rate was noted in children admitted with hypoxemia (p = 0.001), low systolic blood pressure (p = 0.002), hypothermia (p = 0.0001), GCS < or =5 (p = 10(-5)), PTS < or =3 (p = 0.008), hyperglycemia (p = 0.023), coagulation disorders (p = 0.02), and initial intracranial pressure > or =20 mmHg (p = 0.03). Initial hypothermia, hyperglycemia, and coagulation disorders were the only independent predictive factors of mortality.
Conclusion:
Severe head injuries resulting from falls from windows carry a high risk of mortality in less than 6-year-old children. Hypothermia, hyperglycemia, and coagulation's disorders are independent predictive factors of mortality. Early deaths could be considered as direct consequences of uncontrollable brain lesions.
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