Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Abstract

Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A twocenter retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.

Effective ICP Reduction by Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury Treated by an ICP-Targeted Therapy

“…We have previously reported our results in adults and in children using this concept, where a mortality rate of about 10% and a favorable outcome (GOS 5 and 4) in approximately 70% of the patients treated was demonstrated (Naredi et al, 2001;Wahlstrom et al, 2005). In the present study, these results were confirmed in patients with DC as an additional step in the TBI treatment.…”

“…This treatment concept was introduced in our clinical practice in 1994. Four outcome studies published from three different university hospitals in Sweden using the protocol have shown a mortality rate of about 10% and favorable outcomes as indicated by Glasgow Outcome Scale (GOS) 4-5 in 70% of the patients suffering from severe TBI (Eker et al, 1998;Naredi et al, 1998Naredi et al, , 2001Wahlstrom et al, 2005). In 1997, we introduced the use of decompressive hemi-craniectomy as an additional step in our protocol-guided treatment of TBI.…”

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

“…That the study group so defined was "severe" is supported by the overall mortality rate of 24%, which is comparable to mortality rates for severe TBI among children defined by GCS or AIS scores in contemporary case series and prospective trials. 2,9,11,17,24,25,34,35,39,40,43,44,46,47 Nevertheless, the rate of neurosurgical procedures in the current study group (46.8%) was unexpectedly low. Even among admissions lasting 2 days or longer and ending in death, the rate of neurosurgical procedures was only 67.3%.…”

Absence of electroencephalographic seizure activity in patients treated for head injury with an intracranial pressure–targeted therapy

“…The median time between accident and arrival in our hospital is ~ 8 hours. 21,38 This is due to the size of our catchment area, 1000 km to the north, 600 km to the south, and 400 km to the west. Therefore, it is impossible for us to initiate EEG monitoring as early as Vespa et al 37 reported, but we are able to start well within the time frame reported by Ronne-Engström and Winkler.…”

“…We have previously published our outcome results, [20][21][22]38 which showed a favorable outcome in the range of 70% and a mortality of < 15%. One factor contributing to the good outcome could be that we have a low frequency of or no EEG seizures.…”