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Mortality in Children With Severe Head Trauma: Predictive Factors and Proposal for a New Predictive Scale
José Roberto Tude Melo1, Federico Di Rocco, Stéphane Blanot
11Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France; and Postgraduate Program in Medicine and Health, School of Medicine, Federal University of Bahia, Bahia, Brazil 2Departement of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France 3Pediatric Surgical Critical Care Unit and Anesthesiology, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris-France, Université Descartes Paris 5, Paris, France 4Postgraduate Program in Medicine and Health, School of Medicine, Federal University of Bahia, Bahia, Brazil.
Insights
Identifying key factors like age, Glasgow Coma Scale score, hypothermia, hyperglycemia, and coagulation disorders can predict mortality in severe pediatric traumatic brain injury. A new grading scale aids in assessing this risk.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Public Health
Background:
- Traumatic brain injury (TBI) is a significant global health concern.
- Recognizing secondary brain lesions is vital for improving outcomes in pediatric TBI.
- Systemic factors contributing to TBI severity require further investigation.
Purpose of the Study:
- To determine the primary predictors of mortality in children with severe TBI.
- To develop a grading scale for assessing the risk of death in pediatric TBI patients.
- To identify modifiable factors influencing TBI outcomes.
Main Methods:
- Retrospective analysis of medical records from a level I pediatric trauma center (2000-2005).
- Inclusion of children with severe TBI.
- Application of multiple logistic regression and receiver-operating characteristic curve analysis to identify mortality predictors.
Main Results:
- 315 children with severe TBI were analyzed; 30% mortality rate.
- Independent predictors of mortality included: age < 2 years, Glasgow Coma Scale score ≤ 5, accidental hypothermia, hyperglycemia, and coagulation disorders.
- A novel prognostic scale (0-6) incorporating these factors demonstrated a mortality range from 1% to 100%.
Conclusions:
- Independent and modifiable predictors of mortality in pediatric TBI were identified.
- A new grading scale effectively correlates with mortality risk.
- This scale can aid in risk stratification and management of pediatric TBI.
Background:
Traumatic brain injury is a public health problem around the world, and recognition of systemic sources of secondary brain lesions is crucial to improve outcome.
Objective:
To identify the main predictors of mortality and to propose a grading scale to measure the risk of death.
Methods:
This retrospective study was based on medical records of children with severe traumatic brain injury who were hospitalized at a level I pediatric trauma center between January 2000 and December 2005. Multiple logistic regression analysis was done to identify independent factors related to mortality. A receiver-operating characteristics curve was performed to verify the accuracy of the multiple logistic regression, and associations that increased mortality were verified.
Results:
We identified 315 children with severe head injury. Median Glasgow Coma Scale score was 6, and median Pediatric Trauma Score was 4. Global mortality rate was 30%, and deaths occurred despite adequate medical management within the first 48 hours in 79% of the patients. Age < 2 years (P = .02), Glasgow Coma Scale ≤ 5 (P < 10), accidental hypothermia (P = .0002), hyperglycemia (P = .0003), and coagulation disorders (P = .02) were all independent factors predicting mortality. A prognostic scale ranging from 0 to 6 that included these independent factors was then calculated for each patient and resulted in mortality rates ranging from 1% with a score of 6 to 100% with a score of 0.
Conclusion:
Independent and modifiable mortality predictors could be identified and used for a new grading scale correlated with the risk of mortality in pediatric traumatic brain injury.
