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Treatment and outcomes for pediatric head injuries in Mississippi

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Abstract

Object

This report summarizes the treatments and outcomes of a large series of patients with pediatric head injuries (PHIs), who were admitted to a tertiary pediatric trauma center at the University of Mississippi Medical Center from January 1, 2003 through December 31, 2006.

Methods

Data were retrieved from the Department of Neurosurgery’s Brain Trauma Registry (BTR) on patients who are ≤16 years old. Data include Glasgow Coma Scale (GCS) and injury severity scores (ISS) on admission and Glasgow Outcome Scale (GOS) scores at 6 months follow-up.

Results

The BTR registered 554 patients with accidental and nonaccidental PHIs. Follow-up was complete in 98.2%. Aggressive first-tier management with ventricular drainage was used to lower intracranial pressure. Vasopressors were used only to correct hypotension. Second-tier therapies were used infrequently. Craniectomies (14 patients) were associated with good outcomes (GOS 4–5) in nine patients; hypothermia (six patients) and barbiturate (four patients) therapies were ineffective. All 439 patients with ISS <25 showed good outcomes. Fifteen of 16 patients with GCS >8 and ISS ≥25 had good outcomes. In 134 patients with severe PHIs (GCS ≤8), all 45 with ISS <25 and 46 with ISS ≥25 showed good outcomes. Forty-three patients with GCS ≤8 and ISS ≥25 had poor outcomes. Of these patients, 38 died; 22 died within 3 days of admission.

Conclusions

This study indicated that poor outcomes occurred only in PHIs with severe generalized trauma. While 28.4% of patients with GSC ≤8 died, more than half of these sustained nonsurvivable injuries. Aggressive medical management with ventricular drainage was the mainstay of therapy.

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Acknowledgement

The authors wish to acknowledge the pediatric intensivists, attending surgeons, and nursing personnel in the pediatric ICU for their dedication to the care of children with head injuries. The authors also wish to thank Laura Day and Carolyn Wilson for secretarial assistance.

Conflicts of interest

The authors have no commercial or proprietary interests in any drug, device, or equipment mentioned in this article.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    William Hanigan, Frances Spinosa, Domenic Esposito & Andrew Parent

  2. SOM, University of Mississippi Medical Center, Jackson, MS, 39216, USA

    Christina Giurintano

  3. Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, 39216, USA

    Craig Hallstrom

  4. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA

    Warren May

Authors
  1. William Hanigan
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  2. Christina Giurintano
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  3. Craig Hallstrom
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  4. Frances Spinosa
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  5. Domenic Esposito
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  6. Andrew Parent
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  7. Warren May
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Corresponding author

Correspondence to William Hanigan.

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Hanigan, W., Giurintano, C., Hallstrom, C. et al. Treatment and outcomes for pediatric head injuries in Mississippi. Childs Nerv Syst 27, 583–590 (2011). https://doi.org/10.1007/s00381-010-1289-5

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  • DOI: https://doi.org/10.1007/s00381-010-1289-5

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