Prognostic factors and outcome of children with severe head injury: an 8-year experience

Chiaretti, Antonio; Piastra, Marco; Pulitanò, Silvia; Pietrini, Domenico; Rosa, Gabriella De; Barbaro, Roberta; Rocco, Concezio Di

doi:10.1007/s00381-002-0558-3

Cited by 145 publications

(119 citation statements)

References 40 publications

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“…Hyperglycemia is indeed more frequently observed in severe head trauma victims and in those that suffered multiple trauma, according to some studies 3,4,6,17,18 . The explanation would be that these patients have a more important metabolic response to injury due to the effects of cortisol, glucagon and epinephrine release, causing intrac-pediatric head trauma: hyperglycemia Melo et al ellular acidosis, lactate accumulation, high blood glucose levels and neuronal injury 6,[19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

“…However, high blood glucose is common in acutely ill neurological patients, even in non-diabetics ones. A consensus regarding the cut-off blood glucose level that would be related to a poor prognosis in children and adolescents with head trauma is still lacking, which makes the comparison of different studies particularly troublesome [3][4][5][6][7][8][9] .…”

mentioning

confidence: 99%

“…Some authors believe that patients with hyperglycemia generally have a low Glasgow Coma Scale (GCS) score [3][4][5][6] , poor neurological prognosis (based on GCS) and a history of severe trauma with significant brain injury 6,7 . It is well known that such acute hyperglycemia is a result of catecholamine' effects 8,9 .…”

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confidence: 99%

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Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Melo

Reis²,

Lemos-Júnior³

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS). Method: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. Results: A total of 340 children were included and 60 (17.6%) had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans. Conclusion: Hyperglycemia was more prevalent in patients with severe head trauma (GCS ≤8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.Key WordS: adolescents, children, head trauma, hyperglycemia, prevalence. Hiperglicemia em pacientes pediátricos com traumatismo craniencefálico: estudo de corte transversalResumo -Objetivo: Verificar a prevalência de hiperglicemia aguda em crianças vítimas de trauma craniencefálico, de acordo com a escala de coma de Glasgow (GCS). Método: estudo prospectivo, de corte transversal realizado por meio do acompanhamento de prontuários médicos de pacientes na faixa etária pediátrica admitidos na unidade de urgência de um hospital de referência vítimas de traumatismo craniencefálico, durante um ano. Consideramos o valor de corte em 150 mg/dL para definição de hiperglicemia. Resultados: 340 crianças foram incluídas no estudo e 60 (17,6%) apresentaram hiperglicemia na admissão. Hiperglicemia esteve presente em 9% dos casos de trauma craniano leve, 30,4% daqueles com trauma craniano moderado e em 49% dos pacientes com trauma craniano grave. Verificamos que, entre as crianças com níveis elevados de glicemia, 85% apresentavam alterações radiológicas verificadas na tomografia computadorizada do crânio. Conclusão: A hiperglicemia foi mais prevalente em pacientes com traumatismo craniano grave (GCS ≤8), assim como naqueles com alterações identificadas na tomografia computadorizada do crânio, independente da presença de politraumatismo.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Melo

Reis²,

Lemos-Júnior³

et al. 2009

Arq. Neuro-Psiquiatr.

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“…The bone fl ap which is removed at the time of surgery can be safely placed in a subcutaneous pouch in the anterior abdominal wall [9]. The outcome following decompressive craniectomy is especially heartening in younger individuals and in children [10].…”

Section: Our Techniquementioning

confidence: 99%

Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

Mathai

Sahoo²

2008

Indian J Surg

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Introduction Decompressive Craniectomy is an effective option in the management of intractable intracranial hypertension. Aim and objectives Neuronal conservation can be achieved by aggressive decompression (hemicraniectomy).Material and methods In this series 12 patients with a Glasgow Coma Scale score of 8 or <8 with increased intracranial pressure underwent decompressive hemicraniectomy.Results The outcomes were prospectively evaluated. Eight patients were victims of traumatic brain injury. There were two patients who had suffered malignant Middle Cerebral Artery Infarctions, one patient had a cerebral venous thrombosis and one, an intracerebral hematoma. Four patients in this cohort died, while fi ve had good outcomes. ConclusionThe rationale and role of this relatively easy but underutilised procedure are discussed.

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“…Several factors, such as hypotension and hypoxia, have been correlated with the development of secondary injuries. [1][2][3][4][5][6][7][8] Other factors, such as the presence of coagulation disorders, are currently being investigated, so as to define their importance among the complex factors that influence the prognosis of patients with traumatic brain injury (TBI).…”

Section: Introductionmentioning

confidence: 99%

Distúrbio de coagulação em crianças e adolescentes com traumatismo cranioencefálico moderado e grave

Affonseca¹,

Carvalho²,

Guerra³

et al. 2007

J. Pediatr. (Rio J.)

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Objectives: To describe the epidemiological profile of children and adolescents with moderate to severe traumatic brain injury admitted to an intensive care unit; to describe the frequency of coagulation disorders in these patients; to determine the relationship between coagulopathy and trauma severity; to assess the factors associated with coagulopathy; and to assess the effect of coagulopathy on the mortality of these patients. Methods:Cross-sectional study with 301 patients aged up to 16 years admitted to an intensive care unit due to moderate to severe traumatic brain injury, carried out over a 5-year period. The coagulation profile was associated with clinical, epidemiological and CT findings. Univariate and multivariate analyses were used to check the association between coagulopathy and mortality.Results: Minimum age was 23 days, and maximum age was 16 years (mean of 7.9 years). About 77% of patients had coagulopathy, whose occurrence was directly associated with the severity of the trauma, but not with the rise in mortality. The factors associated with the presence of coagulopathy were the following: severity of the traumatic brain injury (OR = 2.83; 95%CI 1.58-5.07), diagnosis of brain swelling on cranial computed tomography (OR = 2.11; 95%CI 1.13-4.07) and occurrence of chest and/or abdominal injury (OR = 2.07; 95%CI 1.11-4.00). Approximately 35% of patients died. The multivariate analysis showed that the factors associated with an increased risk of death were presence of sodium disorders (OR = 5.56; 95%CI 2.90-10.65), hypotension in the intensive care unit (OR = 12.58; 95%CI 4.40-35.00) and acute respiratory distress syndrome (OR = 13.57; 95%CI 1.51-121.66). Conclusion:The development of coagulopathy is a frequent complication in patients with moderate to severe traumatic brain injury. Even though it is not closely associated with death in this study, it may be regarded as a marker of injury severity.J Pediatr (Rio J). 2007;83(3):274-282: Traumatic brain injury, blood coagulation, child, adolescent.

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Prognostic factors and outcome of children with severe head injury: an 8-year experience

Cited by 145 publications

References 40 publications

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Hyperglycemia in pediatric head trauma patients: a cross-sectional study

Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

Distúrbio de coagulação em crianças e adolescentes com traumatismo cranioencefálico moderado e grave

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