Child's Nervous System

, Volume 27, Issue 4, pp 583–590

Treatment and outcomes for pediatric head injuries in Mississippi

Authors

    • Department of NeurosurgeryUniversity of Mississippi Medical Center
  • Christina Giurintano
    • SOM, University of Mississippi Medical Center
  • Craig Hallstrom
    • Department of PediatricsUniversity of Mississippi Medical Center
  • Frances Spinosa
    • Department of NeurosurgeryUniversity of Mississippi Medical Center
  • Domenic Esposito
    • Department of NeurosurgeryUniversity of Mississippi Medical Center
  • Andrew Parent
    • Department of NeurosurgeryUniversity of Mississippi Medical Center
  • Warren May
    • Department of MedicineUniversity of Mississippi Medical Center
Original Paper

DOI: 10.1007/s00381-010-1289-5

Cite this article as:
Hanigan, W., Giurintano, C., Hallstrom, C. et al. Childs Nerv Syst (2011) 27: 583. doi:10.1007/s00381-010-1289-5
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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.

Keywords

Pediatric head injuriesTreatmentTrauma registry

Copyright information

© Springer-Verlag 2010