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Pediatric head injury: the critical role of the emergency physician

T A Mayer, M L Walker

    Annals of Emergency Medicine
    |December 1, 1985
    PubMed

    Insights

    Pediatric severe head injuries impact survival. Multiple trauma with head injury significantly increases mortality risk compared to isolated head injuries, highlighting the need for prompt intervention in severe cases.

    Area of Science:

    • Pediatric Neurology
    • Trauma Surgery
    • Critical Care Medicine

    Background:

    • Neurologic injury is a major cause of death and disability in children.
    • Severe head injuries require careful assessment of contributing factors to understand patient outcomes.

    Purpose of the Study:

    • To identify factors influencing outcomes in pediatric patients with severe head injuries (Glasgow Coma Scale ≤ 8).
    • To compare outcomes between isolated head injury and head injury with multiple trauma.

    Main Methods:

    • A consecutive series of 200 pediatric patients with severe head injury were analyzed.
    • Data collected included Glasgow Coma Scale (GCS), presence of mass lesions, oculovestibular reflexes (OVR), pupillary response, intracranial pressure (ICP), and physiological parameters (hypotension, hypoxia, hypercarbia).
    • Outcomes were assessed using the Glasgow Outcome Scale at a minimum of six months post-injury.

    Main Results:

    • Overall mortality was 21.5%. Patients with head injury and multiple trauma (HI + MT) had a significantly higher mortality rate (30%) compared to those with isolated head injury (IHI) (10.5%).
    • While IHI patients exhibited more severe injury indicators (mass lesions, GCS, OVR, pupillary response), HI + MT patients more frequently presented with increased ICP.
    • Hypotension, hypoxia, or hypercarbia were prevalent in both groups, particularly in the HI + MT group (88% of those who died).

    Conclusions:

    • Multiple trauma significantly worsens outcomes for pediatric patients with severe head injury.
    • Physiological derangements like hypotension, hypoxia, and hypercarbia are critical factors, especially in the context of multiple trauma.
    • Further research into managing these complex injuries is warranted to improve survival rates.

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