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Published on: August 16, 2019
Outcomes of Pediatric Traumatic Brain Injury Patients Presenting with or Developing Cerebral Herniation
Sirin Falconi1, Alex Demopoulos1, Reagan Collins1
1School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Insights
Early decompressive craniectomy improved outcomes for pediatric patients with traumatic brain injury (TBI) and herniation. This intervention is crucial, especially in rural settings, despite higher mortality in males.
Area of Science:
- Pediatric neurosurgery
- Trauma critical care
- Pediatric neurology
Background:
- Traumatic brain injury (TBI) is a primary cause of death and disability in children.
- Limited research exists on pediatric TBI outcomes, particularly with cerebral herniation.
- This study focuses on pediatric TBI patients with herniation in a rural setting.
Purpose of the Study:
- To investigate outcomes in pediatric patients with TBI and cerebral herniation.
- To analyze interventional strategies used for these patients.
- To evaluate the impact of interventions in a rural community context.
Main Methods:
- Retrospective review of 50 pediatric patients with TBI and herniation (2011-2020).
- Data collected included injury mechanism, herniation on imaging, Glasgow Coma Scale (GCS) scores, intracranial pressure, Glasgow Outcome Scale (GOS), length of stay, and mortality/morbidity.
- Analysis of procedures performed and 30-day outcomes.
Main Results:
- Early decompressive craniectomy improved morbidity in severe TBI with herniation, despite a higher overall mortality rate (48.4%) compared to non-surgical approaches (29.4%).
- Male pediatric patients with TBI and herniation had a higher mortality rate (51.6%) than females (26.3%).
- Age and behavior at the time of injury may influence outcomes.
Conclusions:
- Traumatic brain injury (TBI) in children, especially with herniation, presents significant challenges with no established treatment guidelines.
- Aggressive surgical intervention, such as decompressive craniectomy, shows promise for improving outcomes in rural pediatric TBI cases.
- Further research is needed to identify factors influencing outcomes in this vulnerable population.
Background:
Traumatic brain injury (TBI) is the leading cause of mortality and morbidity in children. Previous studies evaluated outcomes of adult patients; however, few assessed outcomes of pediatric TBI patients presenting with herniation. This study investigated outcome data in pediatric patients presenting with TBI and cerebral herniation and the interventional strategies used for each patient in a rural community.
Methods:
A dual-institution retrospective review of 50 pediatric patients presenting with TBI and cerebral herniation from January 2011 to December 2020 was conducted. Mechanism of injury; herniation based on radiology findings; admission, presurgery, and postsurgery Glasgow Coma Scale scores; intracranial pressure values; discharge Glasgow Outcome Scale scores; length of stay; intensive care unit length of stay; procedures performed; and 30-day mortality/morbidity were collected for each patient.
Results:
Although a nonsurgical approach led to better outcomes (29.4% vs. 48.4% mortality rate), early intervention with decompressive craniectomy improved morbidity in patients with severe TBI and cerebral herniation. Male patients presenting with TBI complicated by herniation were more likely to have a fatal outcome compared with female patients (51.6% vs. 26.3%). Behavior and age at injury may play a role in these differences.
Conclusions:
TBI remains a serious concern in the pediatric population with no clear guidelines on the optimal treatment. This study highlights the advantage of integrating more aggressive surgical intervention, such as decompressive craniectomy, in rural communities earlier in the hospital course. Future studies should explore additional factors that could contribute to outcomes in this patient population.
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