Abstract
Introduction: Traumatic brain injury (TBI) is the leading cause of paediatric morbidity and mortality in developed countries. Acquired disability can be evaluated by King's Outcome Scale for Childhood Head Injury (KOSCHI).
Objectives: Evaluate care and outcome in children with severe TBI.
Methods: Analysis of clinical and demographic data of children admitted between January 2008 and December 2009 with the diagnosis of severe TBI. KOSCHI was used to assess recovery.
Results: Of 92 admissions for trauma, 47 had severe TBI. The median age was 8 years, PRISM score was 13 and PTS was 6. The leading cause was road traffic accident (57%). Specialized medical teams provided pre-hospital care in 68% of cases. Raised intracranial pressure (ICP) signs were present in 34 cases. Neurosurgical intervention was necessary in 16 children and 10 had invasive ICP monitoring. All children were ventilated, 42 had hyperosmolar therapy (mannitol or NaCl 3%), 5 barbiturate-induced coma and 12 vasoactive drugs. Transcranial dopller (TCD) was performed in 27 children, 18 had raised pulsatility index. There was a good correlation between TCD information and ICP readings. Eight children (17%) died. In the follow-up period 8 children were in KOSCHI category 1, 2 in category 2, 5 in category 3, 11 in category 4 and 21 in category 5.
Conclusions: KOSCHI provides a practical scale for paediatric head injury outcome. A high percentage of patients were discharged without any sequelae and mortality rate was low. Treatment in a PICU and early neurosurgical consultation were determinant for the good outcome.
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Vieira, H., Francisco, A., Vieira, M. et al. 575 Intensive Care Management and Follow-Up of Severe Traumatic Brain Injury in Children. Pediatr Res 68 (Suppl 1), 294–295 (2010). https://doi.org/10.1203/00006450-201011001-00575
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DOI: https://doi.org/10.1203/00006450-201011001-00575