Outcome after severe head injury

Abstract

A consecutive series of 330 severely head-injured patients was studied prospectively. All of the patients were treated with the same protocols by the same physicians and staff in the same intensive care unit. All of the patients had intracranial pressure (ICP) monitoring. Of the 330 patients, 100 were in the pediatric age group (0 to 19 years of age) and 230 were in the adult group (20 to 80 years of age). Statistical analyses were performed with regard to outcome, Glasgow Coma Scale (GCS) score, ICP course, and incidence of surgical lesions. The average emergency room GCS score as well as the 24-hour GCS score for each group was the same. The percentage of patients having ICP that was normal, increased but reducible, and increased but not reducible in each group was the same. The pediatric patients had a significantly higher percentage of good outcomes (43%) than the adult patients (28%) (p less than 0.01). They also had a significantly lower mortality rate (24%) than the adult patients (45%) (p less than 0.01). At 1 year following injury, 55% of pediatric patients had a good outcome compared to 21% of adults (p less than 0.001); this trend was evident at 3 months, with the same p value. Pediatric patients with normal ICP had a higher percentage of good outcomes (70%) than the adult patients with normal ICP (48%) (p less than 0.05). There was no significant difference in outcome in pediatric and adult patients with mass lesions or with increased ICP, regardless of whether or not the pressure was reducible. There was a much higher incidence of surgical mass lesions in adult patients (46%) than in pediatric patients (24%) (p less than 0.001).

Metabolic and Clinical Markers of Prognosis in the Era of CT Imaging in Children with Acute Epidural Hematomas

“…Our data provided no support of the premise that younger age is associated with a lower mortality rate and a better outcome following severe head injury. It appears that the resilience and plasticity of the pediatric nervous system, and its ability to handle injury, does not affect outcome [16]. …”

Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure

“…More than 1 million children sustain head injuries annually; approximately 165,000 require hospitalization [1,2]. Although many with mild brain injury may not have long-term deficit, treatment for minimizing the long-term effects of moderate to severe brain injury has come under focus to lessen the impact of disability upon these children [3].…”

Prognostic Factors in Children with Severe Diffuse Brain Injuries: A Study of 74 Patients

“…Tomberg et al [5]concurred with this hypothesis. Axonal damage appears to be the single most important pathological substrate of DBI, and DAI is the commonest post-traumatic entity in children [32]. If DAI is ‘pure’, basal cisterns are open and intracranial pressure (ICP) is usually normal or mildly elevated [33].…”