Effet de la contusion pulmonaire sur le pronostic du traumatisme crânien grave chez l'enfant

Abstract

Effect of a pulmonary contusion on the outcome of severely head injured children. Objectives: To assess the effects of a pulmonary contusion (PC) on the outcome of a severe head trauma (SHT) in children less than 15-year-old. Study design: Retrospective study. Patients: The study included 30 severely head injured children with a Glasgow Coma Scale score (GCS) ≤ 8, associated with a PC (PC+) diagnosed on a thoracic CT-scan and 30 severely head injured children without PC (PC–). Methods: Outcome was assessed using the Glasgow Outcome Scale (GOS), on discharge and six months later. Age, body weight, gender, GCS, PTS, ISS, hypoxaemia, arterial hypotension, the results of the cerebral CT-scan, the main treatment administered, complications, the duration of tracheal intubation as well as the duration of stay in the intensive care unit (ICU) and in the hospital were compared between groups. Results: GCS median was lower (6 vs 8, P = 0.001) and ISS median higher (25 vs 23, P = 0.0004) in the PC+ group. Hypoxaemia was more frequent in the PC+ group (n = 12 vs n = 0, P = 0.0001). There was no difference between groups regarding the results of cerebral CT scan. Blood transfusion was more frequently used in the PC+ group (n = 14 vs n = 5, P = 0.03). Median duration of tracheal intubation, and of stay in the ICU and in the hospital were shorter in the PC- group (respectively 8 vs 6 days, P = 0.03 ; 10 vs 7.5 days, P = 0.008 ; 13.5 vs 10.5 days, P = 0.01). No difference was observed regarding complications between groups. GOS on discharge was higher in the PC+ group (3 vs 2, P = 0.01). There was an increase in GOS at six months in the two groups, however GOS remained significantly higher in the PC+ group (median values 2 vs 1, P = 0.002). A favourable outcome occurred less frequently in the PC+ group on discharge and at six months (respectively n = 14 vs 25, P = 0.006 ; n = 20 vs 28, P = 0.02). Conclusion: The association of a PC to a severe head trauma is responsible for a poorer outcome in children, probably because, at least in part, a higher incidence of hypoxaemia.