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Épidémiologie des traumatismes crâniocérébraux chez l’enfant

Epidemiology of traumatic brain injury in children

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  • Published:
Réanimation

Résumé

Les traumatismes crâniocérébraux (TCC) graves sont une cause fréquente de décès et de séquelles neurologiques à long terme. L’épidémiologie des TCC graves est mal connue car les définitions diffèrent selon les études. Les études basées en population sont rares, la plupart sont issues de données hospitalières prenant rarement en compte les décès préhospitaliers. L’incidence annuelle des TCC graves dans les pays riches varie de 2,3 à 17 pour 100 000 en utilisant l’échelle de Glasgow et peut atteindre 46 pour 100 000 avec d’autres classifications. Les TCC graves représentent 3 à 10 % des TCC, à l’origine d’une mortalité annuelle de 2,5 à 9 pour 100 000. Les accidents de la circulation représentent la majorité des TCC graves et des décès chez les enfants, largement devant les chutes. La part des chutes, de la maltraitance et des chocs directs est beaucoup plus importante chez les nourrissons. Les TCC infligés, probablement sous-estimés, sont des TCC graves et représentent un quart des décès par TCC graves chez le nourrisson de moins d’un an. La létalité des TCC graves est de 15–20 %. Le taux de séquelles à long terme varie selon le type de séquelles évalué et les outils de mesure. Il est plus élevé après un TCC infligé. Parmi les enfants avec TCC grave, un tiers développe des troubles psychocomportementaux, 20 à 30 % des incapacités et des troubles cognitifs, 60–70 % se plaignent de fatigue, troubles de concentration et de comportement, et dans 50 % des cas des dysfonctions familiales surviennent.

Abstract

Severe traumatic brain injury (TBI) is a frequent cause of death and long-term disabilities. The epidemiology of severe TBI is not well-known due to variations in TBI definitions among the studies. Population based-studies are scarce, mostly including hospitalization data and rarely deaths on the scene. The annual incidence of severe TBI in the developed countries varies from 2.3 to 17 per 100,000 if based on Glasgow coma scale and reaches 46 per 100,000 if based on others classifications. Severe TBI represents 3 to 10% of all TBIs. The annual mortality rate of severe TBI varies from 2.5 to 9 per 100,000. The most frequent cause of severe TBI and TBI-related death in children is road accidents, falls being less frequent. Percentages of fall, child abuse, and direct hit by objects are higher in infants. Inflicted TBI, probably underestimated, belong to severe TBI and represent one quarter of severe TBI-related deaths in infants of less than one year. The case-fatality rate of severe TBI is around 15–20%. The rate of long-term disabilities varies according to the type of assessed disability and the tools used for its measurement. It is higher following an inflicted TBI. Among children with severe TBI, one third develops psycho-behavioral disorders, 20 to 30% disabilities and cognitive disorders and 60–70% fatigue, behavioral and concentration disorders. In more than 50% of TBI cases, familial dysfunctions occur.

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Authors and Affiliations

  1. Service d’urgences et de réanimation pédiatriques de l’hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59 boulevard Pinel, F-69677, Bron, France

    É. Javouhey

  2. Unité mixte de recherche et de surveillance transport travail environnement, UMRESTTE, UMR-T 9405, Ifsttar et Université Claude Bernard Lyon 1, 25 avenue François Mitterrand, F-69675, Bron, France

    É. Javouhey

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Javouhey, É. Épidémiologie des traumatismes crâniocérébraux chez l’enfant. Réanimation 22, 583–592 (2013). https://doi.org/10.1007/s13546-013-0733-4

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