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Treatment and outcomes for pediatric head injuries in Mississippi
William Hanigan1, Christina Giurintano, Craig Hallstrom
1Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. WHanigan@umsmed.edu
Insights
Pediatric head injuries (PHIs) with severe generalized trauma led to poor outcomes. Aggressive management, including ventricular drainage, was key, with most deaths occurring in patients with nonsurvivable injuries.
Area of Science:
- Pediatric Neurosurgery
- Trauma Care
- Neurological Surgery
Background:
- Pediatric head injuries (PHIs) are a significant cause of morbidity and mortality in children.
- Effective management strategies are crucial for improving outcomes in pediatric trauma patients.
Purpose of the Study:
- To summarize treatments and outcomes for pediatric head injuries (PHIs) at a tertiary pediatric trauma center.
- To analyze the impact of various management strategies on patient outcomes.
Main Methods:
- Retrospective review of the Brain Trauma Registry (BTR) for patients aged ≤16 years.
- Data collected included Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Glasgow Outcome Scale (GOS) at 6 months.
- Analysis of treatment modalities such as ventricular drainage, vasopressors, craniectomy, hypothermia, and barbiturate therapy.
Main Results:
- 554 patients with accidental and nonaccidental PHIs were analyzed, with 98.2% follow-up.
- Aggressive management with ventricular drainage was the primary approach for elevated intracranial pressure.
- Poor outcomes were exclusively observed in patients with severe generalized trauma; 28.4% of those with GCS ≤8 died, often from nonsurvivable injuries.
Conclusions:
- Severe generalized trauma is the primary determinant of poor outcomes in pediatric head injuries.
- Aggressive medical management, particularly ventricular drainage, is the cornerstone of therapy.
- Specific interventions like hypothermia and barbiturate therapy showed limited efficacy in this cohort.
Object:
This report summarizes the treatments and outcomes of a large series of patients with pediatric head injuries (PHIs), who were admitted to a tertiary pediatric trauma center at the University of Mississippi Medical Center from January 1, 2003 through December 31, 2006.
Methods:
Data were retrieved from the Department of Neurosurgery's Brain Trauma Registry (BTR) on patients who are ≤16 years old. Data include Glasgow Coma Scale (GCS) and injury severity scores (ISS) on admission and Glasgow Outcome Scale (GOS) scores at 6 months follow-up.
Results:
The BTR registered 554 patients with accidental and nonaccidental PHIs. Follow-up was complete in 98.2%. Aggressive first-tier management with ventricular drainage was used to lower intracranial pressure. Vasopressors were used only to correct hypotension. Second-tier therapies were used infrequently. Craniectomies (14 patients) were associated with good outcomes (GOS 4-5) in nine patients; hypothermia (six patients) and barbiturate (four patients) therapies were ineffective. All 439 patients with ISS <25 showed good outcomes. Fifteen of 16 patients with GCS >8 and ISS ≥25 had good outcomes. In 134 patients with severe PHIs (GCS ≤8), all 45 with ISS <25 and 46 with ISS ≥25 showed good outcomes. Forty-three patients with GCS ≤8 and ISS ≥25 had poor outcomes. Of these patients, 38 died; 22 died within 3 days of admission.
Conclusions:
This study indicated that poor outcomes occurred only in PHIs with severe generalized trauma. While 28.4% of patients with GSC ≤8 died, more than half of these sustained nonsurvivable injuries. Aggressive medical management with ventricular drainage was the mainstay of therapy.
