Abstract
Purposes
The aims of this study are to describe a cohort of head-injured pediatric patients, focusing on current practice for intracranial pressure (ICP) monitoring and treatment and to verify the relationship between clinical and radiological parameters and the six-month outcome in a multivariable statistical model.
Methods
A retrospective review was done of a prospectively collected database considering patients younger than 19 years admitted to three neuro-intensive care units (ICU). Patients were divided into four age groups: 0–5 (infant), 6–12 (children), 13–16 (pre-adolescent) and 17–18 years (adolescent). The ICP and cerebral perfusion pressure (CPP) were analyzed calculating average data and values exceeding thresholds for more than 5 min. Outcome was assessed 6 months after trauma using the Glasgow Outcome Score.
Results
There were 199 patients, 155 male, included. Sixty percent had extracranial injuries. Pupils were abnormal in 38 %. Emergency evacuation of intracranial hematomas was necessary in 81 cases. The ICP was monitored in 117 patients; in 87 cases ICP was higher than 20 mmHg, with no differences among age groups. All but six patients received therapy to prevent raised ICP; barbiturates, deep hyperventilation or surgical decompression were used in 31 cases. At 6 months, mortality was 21 % and favorable outcome was achieved by 72 %. Significant predictors of outcome in the multivariable model were the Glasgow Coma Scale (GCS) motor score, pupils and ICP.
Conclusions
Pediatric head injury is associated with a high incidence of intracranial hypertension. Early surgical treatment and intensive care may achieve favorable outcome in the majority of cases.
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Acknowledgments
The help of the medical staff, residents and medical students in the three ICUs in data collection is gratefully acknowledged. Rosalia Paternò, M.D., deserves special credit for the final cleaning of the NeuroLink database. The consultancy of Angelo Colombo, M.D., was essential for the statistical analysis. The contribution of Alessia Vargiolu, Ph.D., is also gratefully acknowledged.
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Sigurtà, A., Zanaboni, C., Canavesi, K. et al. Intensive care for pediatric traumatic brain injury. Intensive Care Med 39, 129–136 (2013). https://doi.org/10.1007/s00134-012-2748-0
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DOI: https://doi.org/10.1007/s00134-012-2748-0