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Published on: January 20, 2023
[Severe traumatic braininjury in children and adolescents]
Luís Fernando Andrade de Carvalho1, Carolina de Araújo Affonseca2, Sérgio Diniz Guerra3
1UTI Pediátrica, Hospital João XXIII, FHEMIG.
Insights
Severe traumatic brain injury (TBI) in children has high mortality, influenced by factors like low Glasgow Coma Score and hypotension. Aggressive intensive care may improve outcomes.
Area of Science:
- Pediatric neurology
- Neurotraumatology
- Critical care medicine
Context:
- Traumatic brain injury (TBI) is a significant cause of mortality and morbidity in children and adolescents.
- Mortality rates for pediatric TBI range from 10% to 55%, varying by study criteria and care setting.
- Pediatric TBI mortality is generally lower than in adults.
Purpose:
- To critically review severe TBI in children and adolescents.
- To analyze mortality rates and factors associated with poor outcomes in pediatric TBI.
- To identify potential areas for improved management and outcomes.
Summary:
- Systematic review of MEDLINE, SciElo, Lilacs, and relevant guidelines identified key factors influencing TBI outcomes.
- Increased mortality in pediatric TBI is linked to low Glasgow Coma Score, hypotension, cerebral swelling, and low cerebral perfusion pressure.
- Effective management of severe TBI involves correcting secondary brain insults through aggressive resuscitation, surgery, and intensive monitoring.
Impact:
- Despite numerous studies, factors predicting better outcomes in severe pediatric TBI remain unclear.
- Aggressive fluid resuscitation, surgical intervention, and meticulous intensive care are crucial for mitigating secondary brain injury.
- Further research is needed to elucidate factors promoting favorable outcomes in pediatric TBI survivors.
Background And Objectives:
Present a critical review of traumatic brain injury (TBI) in children and adolescents, focusing on severe TBI, the mortality and the factors related with poor outcome.
Contents:
It was made a systematic review in MEDLINE, SciElo e Lilacs, with the key words: traumatic brain injury, craniocerebral trauma, children and mortality. The most important articles related in the Guidelines of Brain Trauma Foundation (2000 e 2003) were selected too. TBI is one of the most important causes of mortality and morbidity in children and adolescents, and morbidity in children and adolescents. The mortality variation was between 10% and 55%, depending of the patients select criteria, trauma severity and units where the studies were made. The children mortality was, in general, lower than that found in adults and the most important factors related with an increased mortality were: Glasgow Coma Score, hypotension, cerebral swelling and lower cerebral perfusion press. Severe TBI endpoint treatment is to correct the secondary brain lesions related factors.
Conclusions:
The factors related with better outcomes in children with severe TBI are still obscures, despite the large number of studies, large numbers of studies. Many of these factors can be avoided or correct by aggressive fluid resuscitation, surgery treatment, monitoration and adequate intensive care.
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