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Head injuries in children under 36 months of age. Demography and outcome
Y S Hahn1, C Chyung, M J Barthel
1Division of Pediatric Neurosurgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614.
Insights
A new Children's Coma Scale (CCS) aids in assessing pediatric head injuries. This modified scale, based on the Glasgow Coma Scale (GCS), proves effective for predicting outcomes in young children with traumatic brain injuries.
Area of Science:
- Pediatric Neurology
- Traumatic Brain Injury Research
- Clinical Assessment Tools
Background:
- Head injuries in young children (<3 years) lack objective neurological assessment tools.
- Existing scales like the Glasgow Coma Scale (GCS) have limitations in this age group.
Purpose of the Study:
- To develop and validate a modified scale, the Children's Coma Scale (CCS), for neurological assessment in pediatric head injuries.
- To evaluate the CCS's utility in predicting outcomes for children under 3 years old.
Main Methods:
- Prospective application of the CCS, modifying the verbal response subscore of the GCS.
- Study included 738 head-injured patients (0-16 years), with 318 under 3 years, from 1981-1985.
- Analysis of injury mechanisms, loss of consciousness, lucid intervals, seizures, and brain-stem reflexes.
Main Results:
- Falls were the most common injury mechanism (75.5%).
- Prolonged loss of consciousness (>6h) was uncommon (5.0%).
- Oculovestibular reflex and fixed dilated pupils showed the strongest correlation with outcome.
Conclusions:
- The Children's Coma Scale (CCS) is a valuable tool for predicting outcomes in pediatric head injuries.
- Post-traumatic seizures were more frequent in children under 2 years.
- Specific brain-stem reflexes are more reliable indicators of outcome than others.
Abstract:
Head injuries in children under the age of 3 years have not been extensively studied, due in part to the lack of an objective tool for neurological assessment. We have developed a Children's Coma Scale (CCS) by modifying the verbal response subscore of the Glasgow Coma Scale (GCS) to overcome this limitation. When applied prospectively to children under 3 years of age, we found the CCS to be useful in predicting outcome. During the 5-year study period from 1981 to 1985, there were 738 patients with head injuries (0-16 years) admitted to the Children's Memorial Hospital in Chicago, including 318 (43.1%) less than 3 years of age. Initial data demonstrated the following observations. The most common mechanism of injury was a fall (75.5%). Although a brief loss of consciousness (LOC) was reported in three-fourths of the patients, prolonged LOC of more than 6 h was uncommon (16/318, 5.0%). The classically described "lucid interval" was seen in only 7 children (2.2%) and was not a reliable indicator of epidural hematoma. Post-traumatic seizures developed more commonly in children under 2 years of age (15.7%) than in older children (11.6% under 3 years of age, 9.6%, entire group), (P less than 0.001). Oculovestibular reflex and bilateral fixed dilated pupils had the most reliable correlation with outcome. Other brain-stem reflexes were less useful.(ABSTRACT TRUNCATED AT 250 WORDS)