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

Abstract

Severe diffuse brain injury in children has a devastating influence on their physical and psychological development. This retrospective study was undertaken to analyse the factors that influence outcome in children with such injuries. The short-term outcomes (Glasgow outcome score) of 74 children (age ≤15 years) with severe diffuse brain injury and no focal operable mass lesions on CT scan, admitted between 1992 and 1998 at the National Institute of Mental Health and Neurosciences were analysed. The prognostic factors analysed were age, gender, time after injury to admission, nature of injury, highest post-resuscitation Glasgow coma score (GCS), pupillary reaction, horizontal oculocephalic reflex and CT scan findings. The following factors were found to be independent predictors of poor outcome: GCS 3–5 (p < 0.003), absent verbal response (p < 0.001), motor response score of 1–3 (p < 0.001), absent pupillary reaction (p < 0.001), absent oculocephalic reflex (p < 0.001) and presence of traumatic subarachnoid haemorrhage on CT scan (p < 0.002). These independent variables were then subjected to a stepwise logistic regression analysis, and the most important variables for predicting outcome were oculocephalic reflex and GCS, which together correctly predicted unfavourable outcome with a sensitivity of 79% and a specificity of 65%. An early CT scan or a single CT scan did not have any prognostic significance.

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

“…Once brain damage is suspected, several neurological sequelae have been described, with no clear trend towards an specific brain injury. 31,33,34 Follow-up of these patients, has shown that partial to complete recovery of these findings is registered in the longterm evolution of many patients. Pediatric brain damage, when not extreme, still holds some margin of recuperation, and 1 year after cardiac arrest, even the majority of those who had worsen their neurological scales, showed some improvement.…”

Severe head injury among children: computed tomography evaluation as a prognostic factor

“…Along these lines, Hirsch and colleagues [13] found a relation between the initial HCT and prognosis in a study that included scans from 248 children, and Pillai and colleagues [14] showed that oculocephalic reflex and GCS were the most important variables for predicting outcome. A recent study performed at a Canadian hospital [15] that included 83 children with moderate (GCS Fig.…”

Psychological and adjustment problems due to acquired brain lesions in childhood: A comparison between post-traumatic patients and brain tumour survivors

“…In post-traumatic patients these disorders may vary according to several factors such as different recovery stages and gender [8][9][10][11][12], but also have different features depending on patient's age [13]. These children mainly show attention deficits, hyperkinesia and hyperactivity, irritability, aggressiveness and opposition behaviour [14,15].…”