Intensive Care Medicine

, Volume 39, Issue 1, pp 129–136

Intensive care for pediatric traumatic brain injury

  • A. Sigurtà
  • C. Zanaboni
  • K. Canavesi
  • G. Citerio
  • L. Beretta
  • N. Stocchetti
Pediatric Original

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

Neurotrauma Pediatrics Intracranial pressure Cerebral perfusion pressure Outcome 

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)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • A. Sigurtà
    • 1
  • C. Zanaboni
    • 2
  • K. Canavesi
    • 1
  • G. Citerio
    • 3
  • L. Beretta
    • 4
  • N. Stocchetti
    • 1
  1. 1.Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoNeurointensive Care Unit and University of MilanMilanItaly
  2. 2.Anesthesia and Intensive CareIstituto Giannina GasliniGenovaItaly
  3. 3.Neurointensive Care UnitAzienda Ospedaliera San GerardoMonzaItaly
  4. 4.Neurointensive Care UnitFondazione San RaffaeleMilanItaly

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