Severe pediatric head injuries (I). Epidemiology, clinical manifestations and course

Abstract

ObjectiveTo describe the epidemiology, clinical manifestations and evolutive characteristics of pediatric patients with severe head injury (SHI). Material and methodA review was made of the patients admitted to the pediatric intensive care unit (PICU) with SHI between July 1983 and December 2009. ResultsOf the 389 patients with head injuries admitted to the PICU during the study period, 174 (45%) presented SHI. The mean age in this group was of 67±9 months, with a Glasgow Coma Score (GCS) of 5.5±1.8 and a PRISM score of 10.7±6.7. The most frequent etiology of SHI was traffic accidents (56%), though these have decreased significantly in the last decade (58.5% vs 45.3%; p<0.001). Twenty-one percent of the patients required evacuation of the lesions detected by computed tomography (CT), and 39% presented severe diffuse encephalic injury (DEI). Seventy-nine percent of the patients in whom intracranial pressure (ICP) was monitored presented intracranial hypertension. Sequelae of clinical relevance were recorded in 59 patients (39%), and proved serious in 64% of the cases. The mortality rate in this patient series was 24.7%. Intracranial hypertension decreased significantly in the last decade (88% vs 54%; p<0.05), and clinical recovery has improved (23.3% vs 63.1%; p<0.001). Conclusions(a) The incidence of traffic accidents has decreased in the last decade in the studied population; (b) patients with SHI in which ICP was monitored showed a high incidence of intracranial hypertension; (c) morbidity–mortality among pediatric patients with SHI has decreased over the course of the study period.