Child's Nervous System

, Volume 18, Issue 3, pp 129–136

Prognostic factors and outcome of children with severe head injury: an 8-year experience

  • Antonio Chiaretti
  • Marco Piastra
  • Silvia Pulitanò
  • Domenico Pietrini
  • Gabriella De Rosa
  • Roberta Barbaro
  • Concezio Di Rocco
Original Paper

DOI: 10.1007/s00381-002-0558-3

Cite this article as:
Chiaretti, A., Piastra, M., Pulitanò, S. et al. Child's Nerv Syst (2002) 18: 129. doi:10.1007/s00381-002-0558-3

Abstract.

Objectives: Our aim was to analyze prognostic factors and their association with outcome among children with severe head injury. Methods: We conducted a retrospective study among children with severe head injury admitted to our Pediatric Intensive Care Unit (PICU) from November 1992 to December 2000. The patients were immediately evaluated for the severity of head injury (Glasgow Coma Score, GCS), clinical presentation, cerebral axial tomography, early complications (hypoxia and hypotension), metabolic and hematological alterations and early post-traumatic seizures. Six months after injury we applied the Glasgow Outcome Score (GOS). Correlations with GOS were evaluated using univariate and multivariate logistic models. Results: In all, 122 children with severe head injury were identified. The patients presented the following scores: 18 (14.7.0%) children had a GOS of 1; 2 had a GOS of 2 (1.6%); 27 (22.2%) a GOS of 3 and 75 (61.5%) a GOS of 4 or 5. A low GOS was significantly and independently associated with low GCS, multiple trauma, the presence of hypoxia and hypotension, disseminated intravascular coagulation (DIC), hyperglycemia and early post-traumatic seizures. Hematological alterations (white blood cells) were also associated with a low GOS, though not significantly. Conclusion: In addition to GCS, types of trauma and brain lesion, hypoxia and hypotension, hemocoagulative disorders (DIC), hyperglycemia and early post-traumatic seizures are predictors of GOS. A knowledge of these prognostic factors and the correct management of children with severe head injury helps clinicians to improve outcome and to reduce morbidity and mortality.

Severe head injury Childhood Glasgow Outcome Score Prognostic factors Therapeutic algorithms

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Antonio Chiaretti
    • 1
  • Marco Piastra
    • 1
  • Silvia Pulitanò
    • 1
  • Domenico Pietrini
    • 2
  • Gabriella De Rosa
    • 1
  • Roberta Barbaro
    • 1
  • Concezio Di Rocco
    • 3
  1. 1.Pediatric Intensive Care Unit, Gemelli Hospital, Largo Gemelli, 00168 Rome, ItalyItaly
  2. 2.Department of Anesthesiology, Gemelli Hospital, Largo Gemelli, 00168 Rome, ItalyItaly
  3. 3.Pediatric Neurosurgery, Gemelli Hospital, Largo Gemelli, 00168 Rome ItalyItaly