Outcome in children with severe head injuries

Esparza, J.; M-Portillo, Jaime; Sarabia, Maria; Yuste, José Anastasio Fernández; Roger, R; Lamas, Eduardo

doi:10.1007/bf00706691

Cited by 72 publications

(31 citation statements)

References 14 publications

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“…The results were similar to Esparza et al's pediatric study. 25,26 The difference in event rates in children may be explained by the higher ratio of cranial content and higher frequency of swelling compared to adults. 9 The study's methodological limitations may have influenced the results.…”

Section: Discussionmentioning

confidence: 99%

Fatores associados à hipertensão intracraniana em crianças e adolescentes vítimas de traumatismo crânio-encefálico grave

Guerra

Carvalho

Affonseca

et al. 2010

J. Pediatr. (Rio J.)

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Objective: To analyze factors associated with intracranial hypertension in pediatric patients who suffered severe head injuries. Methods:Retrospective cohort study, with data collected from September 1998 through August 2003, including patients aged 0 to 16 who suffered severe head injuries, Glasgow score < 9, and submitted to intracranial pressure (ICP) monitoring (n = 132). Intracranial hypertension (IH) was defined as an episode of ICP > 20 mmHg requiring treatment, while refractory IH was ICP over 25 mmHg requiring barbiturates or decompressive craniectomy. Univariate analysis was followed by multivariate analysis; variables were considered significant if p < 0.05. Results:Ages ranged from 2 months to 16 years, median age 9.7 (6.0-2.3) years. Glasgow scores ranged from 3 to 8, median 6 (4-7). Traffic accidents were responsible for 79.5% of events. Monitoring devices were installed, on average, 14 hours after trauma, median time 24 hours. One hundred and three patients (78%) had IH, while 57 (43.2%) had refractory IH. In multivariate analysis, younger age ranges were associated with IH [relative risk = 1.67 (1.03-2.72); p = 0.037], and abnormal postures were associated with refractory IH [relative risk = 2.25 (1.06-4.78)]. The group mortality rate was 51.5%; it was correlated with use of barbiturates in refractory IH and low cerebral perfusion pressure at the intensive care unit.Conclusions: IH and refractory IH were frequent events in pediatric patients who suffered severe head injuries. The younger the patient, the greater the chance of developing IH. The presence of abnormal postures was found to be a risk factor for refractory IH. No conflicts of interest declared concerning the publication of this article.Suggested citation: Guerra SD, Carvalho LF, Affonseca CA, Ferreira AR, Freire HB. Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries. J Pediatr (Rio J). 2010;86(1):73-79.

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Section: Discussionmentioning

confidence: 99%

Fatores associados à hipertensão intracraniana em crianças e adolescentes vítimas de traumatismo crânio-encefálico grave

Guerra

Carvalho

Affonseca

et al. 2010

J. Pediatr. (Rio J.)

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“…20,46 Recent studies, both clinical and basic science, show variation in clinical outcome following TBI between children and adults ( Table 2). Worse outcomes might be predicted in pediatrics because children have a higher incidence of edema following TBI and a reduced antioxidative capacity compared with adults.…”

Section: Differences In Tbi Within the Pediatric Populationmentioning

confidence: 99%

“…In most current adult and pediatric studies, refractory ICP hypertension is often defined as ICP > 20 mm Hg for some defined time period. 14,20,40 However, no standard definition of ICP hypertension exists in pediatric patients, which poses difficult challenges for designing and comparing clinical trials and results.…”

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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“…Entre los factores clásicamente asociados a la morbilidad del TCE pediátrico 9,18,[26][27][28][29] , en nuestra serie sólo existió asociación significativa en los pacientes que desarrollaron HIC. Este dato es de vital importancia, porque la PIC se monitorizó en un 60% de los pacientes ingresados con TCEG y en ellos en el 79% de los casos existió HIC.…”

Section: Discussionunclassified

Traumatismo craneoencefálico pediátrico grave (II): factores relacionados con la morbilidad y mortalidad

et al. 2011

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ResumenObjetivo: Describir los factores asociados a la morbilidad y mortalidad de los pacientes pediá-tricos con traumatismo craneoencefálico grave (TCEG). Material y método: Revisión de los pacientes ingresados en una unidad de medicina intensiva pediátrica (UMIP) con TCEG en el periodo comprendido entre julio de 1983 y diciembre de 2009. Resultados: De los 389 pacientes con TCE ingresados en nuestra unidad durante el periodo de estudio, presentaron TCEG 174 (45%). La edad media de este grupo fue de 67 + 9 meses, con una puntuación media en la escala de Glasgow (GCS) de 5,5 + 1,8 y una puntuación PRISM media de 10,6 + 6,7. El 39% de los pacientes presentaron lesión encefálica difusa (LED) grave en la TAC. Un 79% de los pacientes en los que se monitorizó la presión intracraneal (PIC) presentaron hipertensión intracraneal (HIC). Estos pacientes tuvieron una mayor incidencia de secuelas graves que aquellos que no desarrollaron HIC (66,7 vs 23,1%; p = 0,01).Las secuelas de relevancia clínica se encontraron en 59 pacientes (34%), y fueron graves en el 64% de los mismos.La mortalidad de los pacientes con TCEG fue de un 25% y se asoció de forma significativa a una menor puntuación del GCS, a la existencia de hiperglucemia o HIC, a la presencia de midriasis o shock y a la necesidad de ventilación mecánica. La mortalidad de la LED grave fue significativamente más elevada que la LED leve-moderada (87,5 vs 7,2%; p < 0,001) y que la lesión focal (87,5 vs 36,1%; p < 0,001). Los factores responsables de la mortalidad de forma independiente en los pacientes pediátricos con TCEG fueron la existencia de midriasis (OR: 31,27), HIC (OR: 13,23) e hiperglucemia (OR: 3,10). * Autor para correspondencia.Correo electrónico: jmloal@hotmail.com (J.M. López Álvarez). 0210-5691/$ -see front matter

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Outcome in children with severe head injuries

Cited by 72 publications

References 14 publications

Fatores associados à hipertensão intracraniana em crianças e adolescentes vítimas de traumatismo crânio-encefálico grave

Fatores associados à hipertensão intracraniana em crianças e adolescentes vítimas de traumatismo crânio-encefálico grave

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Traumatismo craneoencefálico pediátrico grave (II): factores relacionados con la morbilidad y mortalidad

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