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Treatment and outcome of the severely head injured child
Insights
Aggressive neurointensive care for severe pediatric head injuries improved survival rates. However, outcomes may not reach the optimistic levels suggested in recent studies for these critical cases.
Area of Science:
- Pediatric critical care medicine
- Neurotraumatology
- Intensive care medicine
Background:
- Severe head injuries in children present significant management challenges.
- Elevated intracranial pressure (ICP) is a critical factor in pediatric head trauma prognosis.
Purpose of the Study:
- To evaluate the effectiveness of invasive neurointensive care in managing severe pediatric head injuries.
- To identify factors influencing outcomes in children with severe head trauma.
Main Methods:
- Treatment involved invasive neurointensive care including hyperventilation, temperature control, dexamethasone, barbiturates, and continuous ICP monitoring.
- Glasgow Coma Scale (GCS) scores were assessed before treatment.
- Intracranial pressure (ICP), coagulopathy, and brain auditory evoked potentials were monitored.
Main Results:
- Nineteen out of 24 children (79%) survived, with most achieving good recovery.
- Severely elevated ICP, consumption coagulopathy, and abnormal brain auditory evoked potentials were associated with fatal outcomes.
- Twenty patients exhibited moderately to severely elevated ICP; seven developed intracranial hematomas.
Conclusions:
- Prompt resuscitation and aggressive neurointensive care can improve prognosis for severely head-injured children.
- The extent of prognosis improvement may be less than suggested by some recent literature.
- Identifying and managing elevated ICP and coagulopathy are crucial for survival.
Abstract:
Twenty-four children (aged 3 months to 14 years) with severe head injuries were treated by means of invasive neurointensive care for normalizing intracranial pressure (ICP) involving hyperventilation, control of body temperature, dexamethasone, barbiturates and continuous intracranial and arterial pressure monitoring. The Glasgow Coma Scale before initiation of treatment was 3-4 in 8, 5-6 in 9 and 7 in 7 patients. Moderately to severely elevated ICP was observed in 20 patients. Seven developed acute and subacute space occupying intracranial hematomas. Nineteen children (79%) survived, most often with good recovery and 5 (21%) died. Severely elevated ICP, presence of severe consumption coagulopathy and loss of components in brain auditory evoked potentials were significantly more frequent in the fatal group. We conclude that the prognosis of the severely head injured child can be improved by prompt resuscitation and aggressive neurointensive care but probably not, however, to the extent postulated in recent literature.