Variables affecting outcome from severe brain injury in children
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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 wordsBrain injury outcome ICP CPP IGCS
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- 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
- 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
- 10.De Long GR, Glick TH (1982) Encephalopathy of Reye's Syndrome: a review of pathogenetic hypotheses. Pediatrics 69:53Google Scholar
- 11.Fraser CL, Ariefe AI (1985) Hepatic encephalopathy. N Engl J Med 313:859Google Scholar
- 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
- 14.Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: a practical scale. Lancet II:81Google Scholar
- 15.Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: a practical scale. Lancet I:480Google Scholar
- 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
- 24.ean JM, McComb JG (1981) Intracranial pressure monitoring in severe pediatric near-drowning. Neurosurg 9:627Google Scholar
- 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.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