Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry

Abstract

BackgroundIn the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in-hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy.MethodsWe performed a retrospective analysis of the TraumaRegister DGU® from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1–3, 4–6, 7–10, 11–14, 15–17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ failure, and mortality. Additionally, the Glasgow Outcome Scale (GOS) at discharge was observed.ResultsOverall, 1110 children and 6491 adult control patients were included. Comparing the rate of intubation on-scene, the rate of cranial CT scans, the rate of craniotomies, and the rate and length of intensive care treatment, we could only identify minor differences between the age groups. The treatment after discharge from hospital was markedly different due to a very low rate of in-patient rehabilitation treatment in children. On one hand, the rate of systemic complications, such as sepsis and multiple organ failure increased with increasing age. On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury. The in-hospital functional outcome in survivors, according to the GOS, was beneficial for younger children in comparison to adolescents and adults.ConclusionsWe were unable to identify marked age-related differences in the therapeutic approach. Nevertheless, we were able to demonstrate marked differences of outcome. Children younger than 7 years significantly die more often due to direct impact of severe trauma. But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

“…This study identifies the predictors of mortality in school-aged children with severe TBI, which are focused on less in current literature [ 11 , 36 ]. Our results showed that approximately 25% of school-aged children with TBI arrived at the ED with severe TBI.…”

Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers

“…The present study showed that a lower GCS score was significantly related to fatality and injury with a maximum AIS score ≥3, and a higher head AIS score was significantly related to fatality. Traumatic head injury is the leading cause of mortality and disability in children and adolescents [28][29][30][31]. A retrospective study in Australia showed that having a head injury and greater injury severity were associated with a higher mortality rate [32].…”

Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study

“…A previous nationwide Japanese analysis that focused on patients’ age-related characteristics showed that, among younger paediatric patients with severe injury, especially those <10 years, the proportion of those with traumatic head injury was higher than that of the other patients [ 16 ]. Furthermore, traumatic head injury is a leading cause of mortality and disability among children and adolescents [ 19 , 20 , 21 , 22 ]. Our multivariate logistic regression analysis also showed higher odds of in-hospital mortality among those with higher injury severity.…”