Pediatric head injury: A study of 403 cases in a tertiary care hospital in a developing country

Abstract

Introduction:Traumatic brain injury (TBI) in children is a significant cause of morbidity and mortality worldwide. Falls are the most common type of injury, followed by motor vehicle-related accidents and child abuse.Aims and Objectives:The aim and objective of this study was to elucidate the various modes of injury, prognostic factors, complications, incidence of various modes of injury, and outcome in TBI in pediatric population.Materials and Methods:Patients with TBI, 18 years or less in age, managed in our Department of Neurosurgery, over a period of 2 years, were studied prospectively. Detailed history, general physical examination, systemic examination, and central nervous system examination including assessment of Glasgow Coma Scale score (GCS) and pupillary size and reaction were noted in every patient. Based on GCS, patients were divided into mild head injury (GCS 13–15), moderate head injury (GCS 9–12), and severe head injury (GCS ≤8) categories. All the patients were subjected to plain computed tomography (CT) scan head, and CT findings were noted. Patients were managed conservatively or surgically as per the standard indications. The outcome of all these patients was assessed by Glasgow outcome scale and divided into good (normal, moderate disability) and poor (severe, vegetative, dead) outcome. Outcome was assessed in relation to age, sex, GCS, pupil size and reaction, CT scan features, intervention, and associated injuries.Results:A total of 403 patients aged between 1 day and 18 years were included in the study comprising 252 males (63%) and 151 females (37.75%). The common modes of injury were fall 228 (56.6%) followed by road traffic accidents 138 (34.2%), assault 10 (2.5%), and others 27 (6.7%) which include sports injury, hit by some object on head, and firearm injury. Majority of our patients had a GCS of 13–15 (mild head injury), 229 (57.3%), followed by 9–12 (moderate head injury) 119 (29.8%), followed by 8 or less (severe head injury) 52 (13%). In group of patients in the category of GCS ≤ 8, poor outcome was seen in 65.3%, followed by patients in group GCS 9–12 at 2.45% succeeded by group of patients with GCS 13–15 at 2.6%, which was statistically significant (P < 0.0001). A total of 354 (87.8%) patients had normal pupils, 37 (9.2%) had anisocoria, and 12 (3%) patients had fixed dilated pupils. Fixed dilated pupil had poor outcome (100%) followed by anisocoria (40.5%) and normal pupils (16%), which was statistically significant (P < 0.0001).Conclusion:Majority of children who suffer from TBI do well although it still continues to be a significant cause of morbidity and mortality in them. The outcome is directly related to the neurological status in which they present to the hospital.

Injury Causes and Severity in Pediatric Traumatic Brain Injury Patients Admitted to the Ward or Intensive Care Unit: A Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study

“…Considering the overall outcome in our cohort of pediatric TBI patients, a GOSE score of 7 or 8 could be observed in 64% of cases. However, an unfavorable outcome (GOSE 1-4) was still present in 10% of pediatric TBI patients which is comparable to numbers from single-center studies reported from India (10%) and the United States (16%) (13,14). Independent predictors for an unfavorable outcome six months after TBI in pediatric patients who were admitted to the regular ward or ICU were GCS and the occurrence of secondary insults in multivariate analysis.…”

“…Similar to the results from the core dataset, brain injury was classified as serious to severe in most cases (AIS 3 (2-4) ). GCS ratings were also similar to the CENTER-TBI core study with a GCS of 15 (14)(15) in the admission stratum and 12 (7)(8)(9)(10)(11)(12)(13)(14)(15) in the ICU stratum. On brain CT, an abnormality was detected in 49% of pediatric TBI patients in the registry dataset.…”

“…As expected, the total ISS and AIS Brain Injury scores in the ICU stratum were significantly higher than in the admission stratum (26 (17-41) vs. 10 (9-17), p < 0.001 and 4 (4-5) vs. 3 (3-3), p < 0.001, respectively). GCS as well as GCS-motor at admission were significantly higher in the admission stratum compared to the ICU stratum (15 vs. 11 (6)(7)(8)(9)(10)(11)(12)(13)(14); p < 0.00; and 6 (6-6) vs. 5 (1-6); p < 0.001). In the ICU stratum, 28% of patients had no motor response to stimuli at all and one in ten patients had two unresponsive pupils at admission.…”