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[Diffuse traumatic cerebral injuries in children].

E P Sganzerla, R Massei, A De Santis

    Minerva Anestesiologica
    |April 1, 1989
    PubMed
    Summary
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    Severe pediatric head trauma with diffuse lesions shows that diffuse axonal injury has a favorable outcome, while diffuse cerebral swelling leads to high mortality due to intracranial hypertension.

    Area of Science:

    • Neurosurgery
    • Pediatric Traumatology
    • Neuroradiology

    Background:

    • Serious cranioencephalic trauma in children requires accurate prognostic indicators.
    • Computed Tomography (CT) plays a crucial role in assessing the severity and predicting outcomes of pediatric head injuries.

    Purpose of the Study:

    • To analyze the CT findings in pediatric patients with severe head trauma and prolonged coma.
    • To correlate CT-based lesion classification with patient outcomes and mortality rates.

    Main Methods:

    • Retrospective analysis of 41 pediatric patients (<16 years) with severe head trauma (Glasgow Coma Score ≤7, coma >24h).
    • Classification of CT findings into three groups: diffuse axonal damage (Groups A & B) and diffuse cerebral swelling (Group C).
    • Monitoring of intracranial pressure in approximately 50% of patients.

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    Main Results:

    • Patients with diffuse axonal damage (Groups A & B) showed 0% mortality.
    • Patients with diffuse cerebral swelling (Group C) had a 52% mortality rate, primarily due to refractory intracranial hypertension.
    • Overall favorable outcome in over 68% of cases, with a total mortality of 26.8%.

    Conclusions:

    • CT imaging is vital for differentiating pediatric head trauma subtypes with distinct prognoses.
    • Diffuse cerebral swelling in pediatric head trauma is associated with significantly higher mortality than diffuse axonal injury.
    • Early identification of diffuse cerebral swelling is critical for managing intracranial hypertension and improving outcomes.