Abstract
The aim of the study was to evaluate the possible predictive values of clinical examinations combined with the recordings of electroencephalography and brainstem auditory-evoked potentials in traumatic coma of pediatric patients. A total of 43 children in coma with severe acute head trauma were included in the study. They were investigated and treated in pediatric intensive care unit using standard evaluation and treatment protocol. Evaluation of coma was performed using Glasgow Coma Scale. Electroencephalography for 35 patients and brainstem auditory-evoked potentials for 24 patients were recorded. Glasgow coma scale statistic pool median was equal to 4 points as measured in presence of brain edema, meanwhile it was 6 as measured in absence of edema. In case of supratentorial damage, median duration of consciousness recovery was 10 days. In absence of above-mentioned supratentorial damage, recovery of the consciousness was earlier - median was 5 days. Determined duration of artificial lung ventilation was statistically significantly shorter for those who had edema (P=0.048). In 20 patients (57% of all cases), constant or alternating slow wave activity was observed during the first electroencephalographic recording. In other cases, "alpha coma" or low amplitude of arrhythmic activity and local slowing activity corresponding to brain damage seen on computerized tomography were recorded. For 24 patients, brainstem auditory-evoked potentials were recorded. In 9 cases, they were abnormal; in these cases, the consciousness of the patients recovered after 44 days or did not recover. Glasgow coma scale results alone may have limited prognostic value in absence of other objective neurophysiologic investigation data concerning the coma outcome in children. Prognosis may be worse if pathological brainstem auditory-evoked potentials correlate with pathological dynamic changes in electroencephalography and brain lesions, diagnosed during computerized tomography scan.
Highlights
Trauma is the main cause of death for young people and children
Prognosis may be worse if pathological brainstem auditory-evoked potentials correlate with pathological dynamic changes in electroencephalography and brain lesions, diagnosed during computerized tomography scan
Protocol of severe traumatic brain injury treatment was applied in 79% of cases, for this group EEG and BAEP registrations were applied
Summary
Trauma is the main cause of death for young people and children. World Health Organization (WHO) notes that “young people die early frequently and they live longer with disability” [1]. Most of children death cases in Lithuania in year 2005 were related to traffic accidents – 78 cases (41 out of them were teenagers, aged 15–17 years, 28 boys and 13 girls). During the year 2006, 156 children died due to trauma (103 boys and 53 girls); out of this number, 71 teenagers died after injuries acquired in traffic accidents [2]. WHO prognosis says that in 2020, traumatism in traffic accidents will be in the third place among the main health care problems worldwide [1]. Help after traumatic injury and correct means of early detection may improve the outcome after traumatic brain injury, decrease the level of disability in further life
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