Early outcome prediction in severe head injury: comparison between children and adults

Facco, Enrico; Zuccarello, Mario; Pittoni, G; Zanardi, L; Chiarandà, Marta; Davià, G.; Gp, Giron

doi:10.1007/bf00286223

Cited by 37 publications

(7 citation statements)

References 14 publications

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“…However, the prognostic value of GCS has been questioned [10,11,17] because outcome has not always correlated with GCS. Differences in the age of patients, types of injury, and statistical designs might account for this variability.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have indicated that Glasgow Coma Scale (GCS) scores on admission, motor responses, pupillary responses, presence of associated injuries, hypotension, hypoxia, intracranial hemorrhages, and the patient's age are important factors in predicting the outcome of patients with head injuries [3,5,6,11,27,28]. Few reports, however, have correlated GCS scores, morphology of injury on diagnostic imaging, and Glasgow Outcome Scale (GOS) scores in children with traumatic brain stem lesions.…”

Section: Introductionmentioning

confidence: 98%

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Traumatic brain stem lesions in children

Eder

Legat

Gruber

2000

Child's Nervous System

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Glasgow Coma Scale (GCS) scores on admission may be predictors of outcome in patients with brain injuries. This study correlated the outcomes of children with traumatic brain stem lesions with their initial GCS scores and morphological patterns of injury as shown on computed tomography (CT) or magnetic resonance (MR) imaging. During the last 16 years, we have treated 1,108 children with brain injuries. The entire series included only 21 (1.9%) children who had clinical signs of brain stem lesions with morphological correlates on CT or MR imaging. Clinical findings were assessed according to the GCS and compared with scores on the Glasgow Outcome Scale (GOS). Of these 21 children, 16 (76%) had morphological lesions seen on CT scans. In 5 (24%) of the children only the MR images revealed brain stem lesions and their CT scans were negative. Generalized severe brain swelling was present in 6 cases (28%). There was a significant difference in GOS scores between patients with initial GCS scores of 3 and 4 and those with GCS scores between 5 and 7 (P < 0.02). Children with intracranial pressure higher than 40 mmHg had poorer outcomes than patients whose intracranial pressure was lower, but the differences were not significant. Outcome did not correlate significantly with morphological patterns of injury or the presence of extracranial injuries. The GCS is a reliable indicator of severity of injury and of outcome in children with brain stem injuries. MR imaging was more sensitive than CT in detecting brain stem lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Traumatic brain stem lesions in children

Eder

Legat

Gruber

2000

Child's Nervous System

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“…Though severe head injury in children has been extensively studied, most reports include mass lesions in addition to DBI [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]. Fewer reports exist in literature dealing with severe DBI alone and their outcome in children [2, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

“…While Bruce et al [3]and Berger et al [18]have indicated that children with severe DBI have a favourable prognosis, Humphreys et al [19]and Aldrich et al [15]reported very high mortality rates of 39 and 54%, respectively. Several studies have documented age at injury [6, 11, 20, 21], post-resuscitation Glasgow coma score (GCS) [4, 6, 9, 11, 12, 14, 21, 22], pupillary reaction and oculocephalic reflex [4, 8, 22, 23, 24], duration of coma [11], and CT scan evidence of diffuse cerebral oedema and traumatic subarachnoid haemorrhage [2, 4, 10, 11, 13, 15]as the most significant prognosticators of outcome in children with severe head injury. However, few have evaluated the relative importance of these factors in predicting outcome.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Children with Severe Diffuse Brain Injuries: A Study of 74 Patients

Pillai¹,

Praharaj²,

Mohanty³

et al. 2001

Pediatr Neurosurg

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Severe diffuse brain injury in children has a devastating influence on their physical and psychological development. This retrospective study was undertaken to analyse the factors that influence outcome in children with such injuries. The short-term outcomes (Glasgow outcome score) of 74 children (age ≤15 years) with severe diffuse brain injury and no focal operable mass lesions on CT scan, admitted between 1992 and 1998 at the National Institute of Mental Health and Neurosciences were analysed. The prognostic factors analysed were age, gender, time after injury to admission, nature of injury, highest post-resuscitation Glasgow coma score (GCS), pupillary reaction, horizontal oculocephalic reflex and CT scan findings. The following factors were found to be independent predictors of poor outcome: GCS 3–5 (p < 0.003), absent verbal response (p < 0.001), motor response score of 1–3 (p < 0.001), absent pupillary reaction (p < 0.001), absent oculocephalic reflex (p < 0.001) and presence of traumatic subarachnoid haemorrhage on CT scan (p < 0.002). These independent variables were then subjected to a stepwise logistic regression analysis, and the most important variables for predicting outcome were oculocephalic reflex and GCS, which together correctly predicted unfavourable outcome with a sensitivity of 79% and a specificity of 65%. An early CT scan or a single CT scan did not have any prognostic significance.

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“…A few studies have attempted to derive a prognoses from the early findings, but isolated data such as age, duration and/or depth of coma, pupillary reactivity, ocular movements and others have shown little prognostic value.3 6 8 22 [24][25][26][27][28] In a previous study we evaluated the prog-149 nostic value of a number of other single clinical features observed early (in the first week after trauma) and late (after the first month). "7…”

mentioning

confidence: 99%

Prognosis for recovery from prolonged posttraumatic unawareness: logistic analysis.

Sazbon

Fuchs

Costeff

1991

Journal of Neurology, Neurosurgery & Psychiatry

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This study reviews the course and outcome of 130 patients who remained in a state of prolonged unawareness 30 days after severe cranio-cerebral trauma. Prognostic indicators and outcome were fitted by a logistic model. The significant prognostic factors observable in the first week after trauma were found to be ventilatory status, motor reactivity and significant extraneural trauma. The significant prognostic factors after the first month of unawareness were early ventilatory status, early motor reactivity, late epilepsy and hydrocephalus. The estimated probability of recovery of awareness (that is, consciousness) ranged from 0 94 in patients with early decorticate posturing in the absence of both extraneural trauma and ventilatory disturbance to 0-06 in patients with flaccidity, extraneural trauma and ventilatory disturbance in the first week after injury.

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Early outcome prediction in severe head injury: comparison between children and adults

Cited by 37 publications

References 14 publications

Traumatic brain stem lesions in children

Traumatic brain stem lesions in children

Prognostic Factors in Children with Severe Diffuse Brain Injuries: A Study of 74 Patients

Prognosis for recovery from prolonged posttraumatic unawareness: logistic analysis.

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