Intensive Care Medicine

, Volume 14, Issue 4, pp 417–421 | Cite as

Variables affecting outcome from severe brain injury in children

  • Z. Barzilay
  • A. Augarten
  • M. Sagy
  • E. Shahar
  • Y. Yahav
  • H. Boichis
Original Articles


This study evaluates the outcome of 56 severely brain injured children (mean age 6.2±2.1 years) and relates the Initial Glasgow Coma Scale (IGCS), initial intracranial pressure (ICP int), maximal intracranial pressure (ICP max) and minimal cerebral perfusion pressure (CPP min) to quality of survival. Forty-one children sustained head trauma, five severe central nervous system infections and 10 were of miscellaneous etiology. Therapy consisted of mechanical hyperventilation, moderate fluid restriction, dexamethasone and diagnosis specific measures when indicated. Outcome was categorized according to the Glasgow outcome scale at discharge from the hospital. An IGCS of 3 was associated with 100% mortality, 7 and above resulted in 72% good recovery, 28% poor outcome and no mortality. ICP int of less than 20 torr was noted in (67%) of the patients, and did not correlate with ICP max or outcome. Conversely, ICP int in excess of 40 torr correlated well with ICP max and outcome. ICP max of less than 20 torr resulted in 57% good recovery, 36% poor outcome and 7% mortality. ICP max greater than 40 torr resulted in 7% poor outcome and 93% mortality (p<0.001). In head trauma, 32 patients (78%) were alive with mean ICP max 16.9±3.1 and CPP min 65.5±8.5 torr compared to 9 patients (22%) who died with mean ICP max 53.7±10.8 and CPP min 6±3.9 torr, (p<0.01). In children with infectious etiology 60% survived with mean ICP max 16±3 and CPP min 96±16 torr. Forty percent died with ICP max 39±21 and CPP min 65±35 torr. In patients with brain injury of miscellaneous etiology, 60% lived with mean ICP max 17.3±6.2 and CPP min 75±13.4 torr, 40% died with mean ICP max 45.6±7.8 and CPP min 23.3±9.4 torr. Our results indicate favorable outcome in head trauma patients and stress the overall importance of aggressive ICP control and optimal maintenance of cerebral perfusion pressure. The same does not imply in CNS infection, since a mean CPP min of 65±35 torr in non survivors did not affect outcome.

Key words

Brain injury outcome ICP CPP IGCS 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bruce DA, Schut L, Bruno AL, Wood JH, Sutton LN (1978) Outcome following severe head injuries in children. J Neurosurg 48:679PubMedGoogle Scholar
  2. 2.
    Saul GT, Ducker BT (1982) Effect of intracranial pressure monitoring and aggressive treatment on mortality in sever head injury. J Neurosurg 56:498PubMedGoogle Scholar
  3. 3.
    Bowers SA, Marshall LF (1980) Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospecitive analysis. Neurosurg 6:237Google Scholar
  4. 4.
    Bruce DA, Raphaely RC, Goldberg AI, Zimmerman RA, Bilaniuk LT, Schut L, Kuhl DE (1979) Pathophysiology, treatment and outcome following severe head injury in children. Child's Brain 5:174PubMedGoogle Scholar
  5. 5.
    Bruce DA, Berman WA, Schut L (1977) Cerebral fluid pressure monitoring in children: physiology, pathology and clinical usefulness. In: Barness L (ed) Advances in pediatrics. Yearbook Medical Publishers, Chicago, p 233Google Scholar
  6. 6.
    Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB, Harbison JW, Lutz HA, Young HF, Becker DP (1981) Further experience in the management of severe head injury. J Neurosurg 54:289PubMedGoogle Scholar
  7. 7.
    Shapiro HM (1975) Intracranial hypertension: therapeutic and anesthetic considerations. Anesthesiology 43:445PubMedGoogle Scholar
  8. 8.
    Goitein KJ, Tamir I (1983) Cerebral perfusion pressure in CNS infections of infancy and childhood. J Pediatr 103:40PubMedGoogle Scholar
  9. 9.
    Nugent SK, Bausher JA, Moxon ER, et al (1979) Raised intracranial pressure: its management in neisseria meninigitidis meningoencephalitis. Am J Dis Child 133:260PubMedGoogle Scholar
  10. 10.
    De Long GR, Glick TH (1982) Encephalopathy of Reye's Syndrome: a review of pathogenetic hypotheses. Pediatrics 69:53Google Scholar
  11. 11.
    Fraser CL, Ariefe AI (1985) Hepatic encephalopathy. N Engl J Med 313:859Google Scholar
  12. 12.
    Ariefe AI (1986) Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med 314:1529Google Scholar
  13. 13.
    Lassen HA (1974) Control of cerebral circulation in health and disease. Circ Res 34:749PubMedGoogle Scholar
  14. 14.
    Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: a practical scale. Lancet II:81Google Scholar
  15. 15.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: a practical scale. Lancet I:480Google Scholar
  16. 16.
    Miller JD, Becker D, Ward J, et al (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503PubMedGoogle Scholar
  17. 17.
    Becker D, Miller JD, Ward J, Greenberg RP, Young HF, Sakalas R (1977) The outcome from severe head injury with early with early diagnosis and intensive management. J Neurosurg 47:491PubMedGoogle Scholar
  18. 18.
    Goitein KJ, Fainmesser P, Shomer H (1983) Cerebral perfusion pressure and auditory brain stem responses in childhood CNS diseases. Am J Dis Child 137:777PubMedGoogle Scholar
  19. 19.
    Klauber MR, Barrett-Connor E, Marshall LF, et al (1981) The epidemiology of head injury: a prospective study of an entire community — San Diego County, California 1978. Am J Epidemiol 113:500PubMedGoogle Scholar
  20. 20.
    Kraus JF, Black MA, Hessol N, Ley P, Rokaw W, Sullivan L, Bowers S, Knowlton S, Marshall L (1984) The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol 119:186PubMedGoogle Scholar
  21. 21.
    Fife D, Faich G, Hollinshead W, Boynton W (1986) Incidence and outcome of hospital treated head injury in Rhode Island. Am J Public Health 76:773PubMedGoogle Scholar
  22. 22.
    Grosswasser Z, Costeff H, Tamir A (1985) Survivors of severe traumatic brain injury in childhood I. Incidence, background and hospital course. Scand J Rehabil Med (Suppl) 12:6Google Scholar
  23. 23.
    Mickell JJ, Reigel DH, Cook DR, Binda RE, Safar P (1977) Intracranial pressure: monitoring and normalization therapy in children. Pediatrics 59:606PubMedGoogle Scholar
  24. 24.
    ean JM, McComb JG (1981) Intracranial pressure monitoring in severe pediatric near-drowning. Neurosurg 9:627Google Scholar
  25. 25.
    Williams CPS, Swanson AG, Chapman JT (1964) Brain swelling with acute purulent menigitis: report of treatment with hypertonic intravenous urea. Pediatrics 34:220PubMedGoogle Scholar
  26. 26.
    Heisted DD, Kontos HA (1983) Cerebral circulation. In: Shepard JT, Abboud FM, (eds) Handbook of Physiology — the cardiovascular system, II, Vol 3: Peripheral circulation and organ blood flow. Williams and Wilkins, Baltimore, p 137Google Scholar
  27. 27.
    Miller JD, Stanek A, Langfitt TW (1972) Concepts of Cerebral perfusion pressure and vascular compression during intracranial hypertension. In: Meyer JS, Schmede JP (eds) Progress in brain research. Elsevier, Amsterdam, p 411Google Scholar
  28. 28.
    Wagner EM, Traystman RJ (1986) Hydrostatic determinants of cerebral perfusion. Crit Care Med 14:484PubMedGoogle Scholar
  29. 29.
    Gruszkiewicz J, Doron Y, Peyser E (1973) Recovery from severe craniocerebral injury and brain stem lesions in childhood. Surg Neurol 1:197PubMedGoogle Scholar
  30. 30.
    Hendrick EB (1959) The use of hypothermia in severe head injury in childhood. Arch Surg 79:362PubMedGoogle Scholar
  31. 31.
    Bricolo A, Turazzi S, Alexandre A, Rizzuto N (1977) Decerebrate regidity in acute head injury. J Neurosurg 47:680PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • Z. Barzilay
    • 1
    • 2
  • A. Augarten
    • 1
    • 2
  • M. Sagy
    • 1
    • 2
  • E. Shahar
    • 1
    • 2
  • Y. Yahav
    • 1
    • 2
  • H. Boichis
    • 1
    • 2
  1. 1.Pediatric Intensive Care UnitThe Chaim Sheba Medical CenterTel Hashomer
  2. 2.the Tel Aviv University Sackler School of MedicineTel AvivIsrael

Personalised recommendations