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-Secondary cerebral stress of systemic origin in children with severe craniocerebral injuries-
1Service d'accueil des urgences, hôpital R-Salengro, CHRU de Lille, France.
Insights
Secondary brain insults like hypotension and anemia significantly increase mortality and severe disability in children with severe head injuries. These factors worsen outcomes, highlighting the need for prompt management.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Clinical Outcomes Research
Background:
- Severe head injury in children is a major cause of mortality and long-term disability.
- Secondary brain insults of systemic origin (SBISOs) are common complications that can exacerbate neurological damage.
- Understanding the incidence and impact of SBISOs is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of SBISOs, including arterial hypotension, hypoxemia, hypercarbia, and anemia, in severely head-injured children.
- To evaluate the short-term and long-term effects of these SBISOs on mortality and morbidity in pediatric patients.
- To identify specific SBISOs that significantly impact outcomes in severe pediatric head injury.
Main Methods:
- A prospective, open study was conducted over 24 months.
- Seventy-one children under 15 years old admitted to a trauma center with severe brain injury were enrolled.
- Data on SBISOs and patient outcomes were systematically collected and analyzed.
Main Results:
- Twenty-five children presented with SBISOs upon admission, with an overall mortality rate of 37%.
- Children with SBISOs experienced significantly higher rates of severe disability (84%) compared to those without (46%) post-hospitalization.
- Long-term follow-up indicated that SBISOs were associated with poorer recovery, with only one child with SBISOs reporting good recovery versus fifteen without.
Conclusions:
- Hypotension was a critical factor, tripling mortality risk (3.6 times) in severely head-injured children.
- The presence of anemia alongside hypotension further worsened the negative consequences and patient outcomes.
- Effective management of systemic insults is vital for improving survival and functional recovery in pediatric severe head injury.
Objective:
To assess incidence of secondary brain insults of systemic origin (SBISOs) such as arterial hypotension, hypoxaemia, hypercarbia, and anaemia in severely head injured children; to assess their impact on mortality and morbidity in the short- and long-term.
Study Design:
Prospective, open study covering a 24-month period.
Patients:
Seventy-one children, under 15 years of age, admitted to a trauma centre for severe brain injury.
Method:
Analysis of SBISOs and outcome.
Results:
Twenty-five children were admitted with SBISOs. The mortality rate was 37%. After hospitalization, 84% of the children with SBISOs vs 46% without SBISOs had severe disability (Glasgow outcome score = 1, 2 and 3). After 1 year, 20 out of the 45 children still alive were contacted. One of the four with SBISOs communicated a bad recovery. Fifteen children without SBISOs presented good recovery: GOS = 4-5, paediatric overall performance category (POPC scale) = 1-2.
Conclusion:
Hypotension was associated with significant increase in mortality (x 3.6) in children with severe head injury. The consequences were worse when anaemia was associated.