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Severe pediatric head injury: myth, magic, and actual fact
1Children's Hospital, Penn State Geisinger Health System, Milton S. Hershey Medical Center, Hershey, Pa., USA.
Insights
The study debunks the myth of better outcomes for severely head-injured children. Severe head injury outcomes in children and adults involved in motor vehicle accidents show no significant difference in mortality rates.
Area of Science:
- Trauma surgery
- Pediatric critical care
- Neurotrauma
Background:
- A prevailing myth suggests children have better outcomes than adults following severe head injury.
- This perception is often based on reports of lower overall mortality rates in pediatric populations.
Purpose of the Study:
- To investigate and compare the mortality rates of severely head-injured children and adults.
- To determine if children truly have a better prognosis after severe head injury, particularly in motor vehicle accident cases.
Main Methods:
- A retrospective analysis of 4,041 severely head-injured children and 14,789 adults.
- Data collected from five Level I trauma centers between 1986 and 1996.
- Severe head injury defined by Glasgow Coma Scale (GCS) score <8; outcome measured by mortality.
Main Results:
- Overall mortality for severely head-injured children was 36.5%, compared to 47.6% for adults.
- For motor vehicle accident victims, mortality rates were similar: 35% (children 3-11), 31.4% (children 12-18), and 32.5% (adults).
- The lower overall pediatric mortality may be attributed to patient selection bias.
Conclusions:
- Children involved in motor vehicle accidents have a similar likelihood of dying from severe head injury as adults.
- The myth of better outcomes for severely head-injured children compared to adults is not supported by this trauma data, especially in specific injury contexts.
Abstract:
Reports of low mortality rate for severely head-injured children have led to the myth that children have a better outcome than adults after severe head injury. This was examined in the present study by comparing the outcome of 4,041 severely head-injured children with 14,789 adults from five Level I trauma centers in the Pennsylvania Trauma Systems Foundation from 1986 to 1996. Severe head injury was defined as GCS <8, and outcome was defined by mortality. The overall mortality rate for children (<18 years) was 36.5% and for adults 47. 6%. However, for patients involved in motor vehicle accidents, there was no clinically significant difference between children age 3-11 years (35%), age 12-18 years (31.4%) and adults (32.5%). The unprecedented low mortality rate for severe head injury in children was probably due to the selection bias of the patient population. We conclude that children involved in motor vehicle accidents are just as likely to die from severe head injury as adults.