Prognosis of severe head injuries in childhood and adolescence

In a retrospective, non-random study, the effect of supplementary medical treatment (Dexamethasone, barbiturates) was investigated upon the prognosis of severe head injuries. Of 107 children and adolescents up to 16 years of age, 51 were treated with Dexamethasone; 56 received only standard therapy. Evaluation of the results shows that Dexamethasone therapy in high doses clearly reduced mortality in cases of severe head injuries (from 33.3% to 13.6%) without causing any noteworthy neurological defects. Among the individual types of injury, the effect was most evident in cases of intracranial hematoma (drop in mortality from 36.8% to 11.8%). On the other hand, definitive effects of therapy could not be established in the most severely injured patients with extreme brain damage and those with milder forms of trauma without substantial cerebral edema. Barbiturates were given only when severe intracranial pressure could not be alleviated by other means. Remission was successful in a few cases but the total number is not yet sufficient for a conclusive evaluation. Further important factors for prognosis are: depth and length of the initial disturbance of consciousness, age, concomitant injuries as well as some peculiarities of childhood and adolescence (tendency to develop severe cerebral edemas, clustering of atypical intracranial hematomas).