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Effect of multiple trauma on outcome of pediatric patients with neurologic injuries
Insights
Patients with severe head injury and multiple trauma face significantly higher mortality risks than those with isolated head injuries. Early identification and management of associated conditions like shock are crucial for improving outcomes in trauma patients.
Area of Science:
- Trauma Surgery
- Neurocritical Care
- Emergency Medicine
Background:
- Severe head injury is a major cause of mortality and disability.
- Patients with severe head injury often present with concomitant multiple trauma.
- The impact of multiple trauma on outcomes in severe head injury patients requires further investigation.
Purpose of the Study:
- To compare the outcomes of patients with isolated severe head injury versus those with severe head injury and multiple trauma.
- To identify factors contributing to increased morbidity and mortality in patients with combined injuries.
- To evaluate the correlation between injury severity scores and patient outcomes.
Main Methods:
- Retrospective analysis of 95 patients with severe head injury (unconsciousness > 6 hours) over a 3-year period.
- Classification of patients into isolated head injury (n=46) and head injury plus severe multiple trauma (n=49) groups.
- Assessment of head injury severity using Glasgow Coma Score and clinical signs; multiple trauma severity scored using the Modified Injury Severity Scale.
Main Results:
- The multiple trauma group had a 2.5 times higher rate of poor outcomes (death or severe disability) despite having less severe head injuries.
- Shock, refractory hypoxemia, and sepsis were identified as key contributors to increased morbidity and mortality in the multiple trauma group.
- Higher Modified Injury Severity Scale scores were significantly associated with increased morbidity and mortality.
Conclusions:
- Severe head injury patients with multiple trauma experience worse outcomes compared to those with isolated head injuries.
- Aggressive management of systemic insults such as shock, hypoxemia, and sepsis is critical in patients with combined head and multiple trauma.
- The Modified Injury Severity Scale is a valuable tool for predicting outcomes in patients with severe head injury and multiple trauma.
Abstract:
In a 3-year period, 95 patients with severe head injury (unconsciousness greater than 6h duration) were treated at our institution. Of these, 46 patients (48%) had isolated head injury and 49 (52%) had head injury plus severe multiple trauma. Multiple trauma was scored using the Modified Injury Severity Scale. All patients in the multiple trauma group had at least one additional area of severe injury. Severity of head injury, judged by Glasgow Coma Score, presence of mass lesions, abnormal posturing or flaccidity, impaired or absent oculocephalic reflexes, and fixed, dilated pupils, was much greater in the isolated head injury group. In spite of this, poor outcome (death or vegetative/severe disability) was 2 1/2 times as frequent in the multiple trauma group. Shock, refractory hypoxemia and sepsis were contributing factors in this increased morbidity and mortality. Increasing Modified Injury Severity Scale scores were associated with increased morbidity and mortality.