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Head trauma in children, part 1: admission, diagnostics, and findings
Thomas Kapapa1, Kathrin König, Ulrike Pfister
1Department of Neurosurgery, University of Ulm, 89075 Ulm, Germany. Thomas.Kapapa@uniklinik-ulm.de
Insights
Severe head trauma in children is predictable using early clinical indicators. Key factors include shock index, blood pressure, and pupillary response, influencing patient outcomes.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
Background:
- Severe head trauma in children presents unique challenges in diagnosis and outcome prediction.
- Early identification of prognostic factors is crucial for effective management.
Purpose of the Study:
- To identify key preclinical and early clinical factors influencing outcomes in pediatric severe head trauma.
- To correlate diagnostic findings with the Glasgow Outcome Scale in affected children.
Main Methods:
- Retrospective analysis of 48 pediatric patients (0-16 years) with severe head trauma over 3 years.
- Evaluation of clinical findings, biochemistry, and clinical course features against outcome measures.
- Assessment of the Glasgow Coma Score, shock index, blood pressure, and pupillary motoricity.
Main Results:
- Initial shock index (P = .0089), systolic blood pressure (P = .0002), and bradycardia (P = .035) significantly correlated with outcomes.
- Detailed assessment of 'eye opening' within the Glasgow Coma Score (P = .0155) was the most accurate predictor.
- Pupillary motoricity at the accident site (P = .002) and in the emergency room (P = .0004) were strong predictors of outcome.
- Preclinical stabilization and oxygenation had an impact comparable to in-clinical management.
Conclusions:
- Early clinical parameters, including vital signs and pupillary response, are critical for predicting outcomes in pediatric severe head trauma.
- Preclinical management plays a vital role, emphasizing the importance of immediate stabilization and oxygenation.
Abstract:
The objective of this study is to describe and to determine the preclinical situation and early in-clinical situation, diagnostic findings, and factors influencing the outcome of severe head trauma in children. Records of 48 children (0-16 years) were analyzed during a 3-year interval. Correlations with the outcome (Glasgow Outcome Scale) were determined by focusing on different scales, clinical findings, biochemistry, and clinical course features. The initial shock index had a major relevance (P = .0089). Systolic blood pressure (P = .0002) and bradycardia (P = .035) were important factors. Assessing the severity of trauma according to the Glasgow Coma Score, the most accurate parameter for outcome is based on the detailed quality of ''eye opening'' (P = .0155). Pupillary motoricity at the accident site (P = .002) and emergency room (P = .0004) are strong predictors. Preclinical measurements of stabilization and oxygenation have the same impact as the in-clinical management.
