Intensive Care Medicine

, Volume 39, Issue 1, pp 129–136

Intensive care for pediatric traumatic brain injury

Authors

    • Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoNeurointensive Care Unit and University of Milan
  • C. Zanaboni
    • Anesthesia and Intensive CareIstituto Giannina Gaslini
  • K. Canavesi
    • Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoNeurointensive Care Unit and University of Milan
  • G. Citerio
    • Neurointensive Care UnitAzienda Ospedaliera San Gerardo
  • L. Beretta
    • Neurointensive Care UnitFondazione San Raffaele
  • N. Stocchetti
    • Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoNeurointensive Care Unit and University of Milan
Pediatric Original

DOI: 10.1007/s00134-012-2748-0

Cite this article as:
Sigurtà, A., Zanaboni, C., Canavesi, K. et al. Intensive Care Med (2013) 39: 129. doi:10.1007/s00134-012-2748-0

Abstract

Purposes

The aims of this study are to describe a cohort of head-injured pediatric patients, focusing on current practice for intracranial pressure (ICP) monitoring and treatment and to verify the relationship between clinical and radiological parameters and the six-month outcome in a multivariable statistical model.

Methods

A retrospective review was done of a prospectively collected database considering patients younger than 19 years admitted to three neuro-intensive care units (ICU). Patients were divided into four age groups: 0–5 (infant), 6–12 (children), 13–16 (pre-adolescent) and 17–18 years (adolescent). The ICP and cerebral perfusion pressure (CPP) were analyzed calculating average data and values exceeding thresholds for more than 5 min. Outcome was assessed 6 months after trauma using the Glasgow Outcome Score.

Results

There were 199 patients, 155 male, included. Sixty percent had extracranial injuries. Pupils were abnormal in 38 %. Emergency evacuation of intracranial hematomas was necessary in 81 cases. The ICP was monitored in 117 patients; in 87 cases ICP was higher than 20 mmHg, with no differences among age groups. All but six patients received therapy to prevent raised ICP; barbiturates, deep hyperventilation or surgical decompression were used in 31 cases. At 6 months, mortality was 21 % and favorable outcome was achieved by 72 %. Significant predictors of outcome in the multivariable model were the Glasgow Coma Scale (GCS) motor score, pupils and ICP.

Conclusions

Pediatric head injury is associated with a high incidence of intracranial hypertension. Early surgical treatment and intensive care may achieve favorable outcome in the majority of cases.

Keywords

NeurotraumaPediatricsIntracranial pressureCerebral perfusion pressureOutcome

Supplementary material

134_2012_2748_MOESM1_ESM.pdf (34 kb)
Supplementary material 1 (PDF 35 kb)
134_2012_2748_MOESM2_ESM.pdf (26 kb)
Supplementary material 2 (PDF 27 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012