Abstract
To determine the threshold values of Pediatric Index of Mortality 2 (PIM 2) score, Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) score for mortality in children after severe head injury and to evaluate changes in outcomes of children after severe head injury on discharge and after 6 months. All children with severe head injury admitted to the Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital, Lithuania, from January 2004 to June 2006 were prospectively included in the study. The severity of head injury was categorized according to the GCS score < or =8. As initial assessment tools, the PTS, postresuscitation GCS, and PIM 2 scores were calculated for each patient. Outcome was assessed according to Glasgow Outcome Scale on discharge and after 6 months. The study population consisted of 59 children with severe head injury. The group consisted of 37 (62.7%) boys and 22 (37.3%) girls; the mean age was 10.6+/-6.02. The mean GCS, PTS, and PIM 2 scores were 5.9+/-1.8, 4.8+/-2.7, and 14.0+/-19.5, respectively. In terms of overall outcome, 46 (78.0%) patients survived and 13 (22.0%) died. All three scales appeared to be significant predictors of death. Threshold values for which potential mortality in children after severe head injury increased were 10.75 for PIM 2, 3 for PTS and 5 for GCS. PIM 2 score provided the best discrimination between survivors and nonsurvivors. The threshold values for mortality in children after severe head trauma were PIM 2> or =10.75%, PTS< or =3 and GCS< or =5, and these values were significant risk factors of death in severely head injured children. The changes in outcome for survivals on discharge and after 6 months were statistically significant.
Highlights
Trauma remains one of the most important diseases of childhood, accounting for serious, potentially lifelong morbidity and representing the most likely cause of death after the first year of life in developed nations (1, 2)
The threshold values for mortality in children after severe head trauma were PIM 2310.75%, Pediatric Trauma Score (PTS)£3 and Glasgow Coma Scale (GCS)£5, and these values were significant risk factors of death in severely head injured children
All children with severe head injury admitted to the pediatric intensive care unit (PICU) of Kaunas University of Medicine Hospital (KUMH), Lithuania, from January 2004 to June 2006 were prospectively included in the study
Summary
Trauma remains one of the most important diseases of childhood, accounting for serious, potentially lifelong morbidity and representing the most likely cause of death after the first year of life in developed nations (1, 2). Even when less developed nations are included, with proportionally more deaths as a result of infectious diseases and inadequate sanitation, in 2001 injuries accounted for 38.8% of all deaths in children younger than 19 years in Eastern Europe (1). 150 of Lithuanian children younger than 14 years die from unintentional and intentional injuries each year. Mortality from external causes is several times higher in Lithuania than in most European countries. Population-based studies indicate that approximately 25% of children and adolescents younger than 19 years receive medical care for an injury each year. 2.5% require hospitalization, and in 55% of cases, injuries result in at least temporary disability (4)
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