Initial predictive factors of outcome in severe non-accidental head trauma in children

Scavarda, Didier; Gabaudan, C.; Ughetto, Fabrice; Lamy, François-Xavier; Imada, Vanessa; Léna, G.; Paut, O.

doi:10.1007/s00381-010-1150-x

Cited by 25 publications

(20 citation statements)

References 54 publications

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“…17,18 However, its accuracy for the prediction of mortality is still debated. [19][20][21] In our study, the mortality rate was very low (1.8%), and all deaths occurred in patients in the STG (PTS ≤8). Their PTS scores were four or lower.…”

Section: Discussionmentioning

confidence: 57%

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

Anıl¹,

Sarıtaş²,

Bıcılıoğlu³

et al. 2017

cayd

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Introduction:The aim of this study was to assess the efficacy of the Pediatric Trauma Score (PTS) in predicting significant trauma in patients presenting with blunt trauma to a high-level pediatric emergency department. Methods: Patients younger than 15 years of age presenting to the pediatric emergency department of the Tepecik Training and Research Hospital with acute high-energy blunt trauma were analyzed prospectively. The PTS was calculated on arrival at the pediatric emergency department. The patients were classified into two groups as follows: patients with a PTS of ≤8 comprised the significant trauma group, while patients with a PTS of >8 made up the non-significant trauma group. Results: Two-hundred-thirteen children with a mean age of 6.1±3.9 years (range: 10 days-15 years) were included in the study. The frequency of coagulation testing and thorax computed tomography in the pediatric emergency department, need for critical interventions and therapies in the pediatric emergency department, rate of hospitalization, need for transfer to the pediatric intensive care unit, mechanical ventilation, operation, blood transfusion, and mortality rate were statistically higher in the significant trauma group (p<0.05). PTS ≤8 exhibited a sensitivity of 56.2% and a specificity of 90.8% for hospitalization (AUROC: 0.682; 95% confidence interval: 0.610-0.755). The PTS was significantly correlated with length of hospital stay (r=-0.493; p<0.001) and length of observation in the pediatric emergency department (r=-0.442; p<0.01). Conclusion: PTS on arrival at a high-level pediatric emergency department is a good predictor of the need for critical interventions/ therapies and mortality in children with high-energy blunt trauma. However, its accuracy is moderate for the prediction of hospitalization. Keywords: Pediatric Trauma Score, high-energy trauma, mortality, hospitalization Amaç: Çalışmanın amacı, üst düzey bir çocuk acil servisine künt yüksek enerjili travma nedeniyle başvuran çocuklardaki ciddi travmayı öngörmede, Pediyatrik Travma Skoru'nun (PTS) etkin olup olmadığının araştırılmasıdır. Yöntemler: Akut künt yüksek enerjili travma nedeniyle Tepecik Eğitim ve Araştırma Hastanesi'ne başvuran 15 yaşından küçük çocuklar ileriye yönelik olarak incelendi. PTS yaralı acil servise geldiği anda hesaplandı. Hastalar iki gruba ayrıldı: PTS ≤8 (ciddi travma) ve PTS >8 (ciddi olmayan travma). Bulgular: İki yüz on üç çocuk (ortalama yaş: 6,1±3,9 yıl; en küçük: 10 gün -en büyük: 15 yıl) çalışmaya alındı. Acil serviste koagülasyon testi ve toraks tomografisi sıklığı, acil serviste kritik girişim ve tedavi gereksinimi, hastaneye yatış oranı, yoğun bakım gereksinimi, mekanik ventilatör gereksinimi, ameliyat, kan transfüzyonu, ölüm sıklığı PTS ≤8 grubunda daha fazlaydı (p<0,05). PTS ≤8'in duyarlılığı %56,2; özgüllüğü %90,8 (AUROC: 0,682; %95 CI: 0,610-0,755) olarak hesaplandı. PTS hastanede yatış süresi (r=-0,493; p<0,001) ve acil serviste izlenme süresi (r=-0,442; p<0,01) ile anlamlı korelasyon göstermekteydi. Sonuç: Künt yüksek en...

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Section: Discussionmentioning

confidence: 57%

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

Anıl¹,

Sarıtaş²,

Bıcılıoğlu³

et al. 2017

cayd

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“…45 Inflicted (nonaccidental) traumatic brain injury has a particularly poor outcome, reflecting the much higher energy transfer in repeated shaking or shaking-impact injuries. One case series 46 reports about 30% mortality in infants admitted to the pediatric ICU with such injuries.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Predicting outcome after childhood brain injury: Figure 1:

Forsyth¹,

Kirkham²

2012

CMAJ

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“…This was a strong supplemental argument for AHT since retinal hemorrhages have been considered in previous reports as specific signs of abuse from a shaking mechanism when associated with SDH in neonates and toddlers without a clear history of trauma. 1,[8][9][10][12][13][14]16,19,22,[24][25][26]29 SDH is the most common finding on cranial CT scans of patients who are victims of AHT (present in > 70% of cases); 2,3,7,8,23 it is commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages 3,7,8,30 as we found in our sample. The SDHs in our patients were sometimes exclusively hyperdense (acute) or heterogeneous (acute and subacute), due to the natural sedimentation, accumulation of CSF and hemoglobin oxidation in different stages, or were homogeneously hypodense as described by some authors.…”

Section: Discussionmentioning

confidence: 66%

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

Melo

Rocco²,

Bourgeois³

et al. 2014

PED

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Object Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. Methods In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker–Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. Results One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days–23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients initially treated with a subdural-peritoneal shunt. Although 52% of the patients had bilateral SDH, bilateral drainage was only required in 9.4%. Conclusions The choice of treatment should be determined by the clinical and radiological characteristics of the individual case. Although effective on an emergency basis, subdural puncture and external subdural drainage are frequently insufficient to obtain complete resolution of SDH, and temporary placement of a subdural-peritoneal shunt is needed in most cases.

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Initial predictive factors of outcome in severe non-accidental head trauma in children

Abstract: PRISM II is a reliable and easy performing tool for assessing the prognosis of non-accidental cranial traumatism in young children. GCS and PTS, scores even simpler than PRISM II, showed good accuracy regarding survival prediction.

Cited by 25 publications

References 54 publications

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

Predicting outcome after childhood brain injury: Figure 1:

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age

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