Child's Nervous System

, Volume 25, Issue 9, pp 1077–1083

Defenestration in children younger than 6 years old: mortality predictors in severe head trauma

  • Jose Roberto Tude Melo
  • Federico Di Rocco
  • Laudenor Pereira Lemos-Júnior
  • Thomas Roujeau
  • Bertrand Thélot
  • Christian Sainte-Rose
  • Philippe Meyer
  • Michel Zerah
Original Paper

Abstract

Purpose

This study aims to describe the characteristics of severe head injuries in children less than 6 years old, victims of falls from windows, and identify the main predictive factors of mortality in this population.

Patients and methods

A cross-sectional study was designed through data derived from medical records of less than 6-year-old children victims of falls from windows presenting with a severe head injury defined by an initial Glasgow coma scale (GCS) ≤8, hospitalized at a Pediatric Trauma center level III, between January 2000 and December 2005. Statistical analysis used univariate analysis and multiple logistic regressions.

Results

We identified 58 severe head injuries in children victims of falls from windows. The mean age was 2.8 ± 1.4 years, with a male prevalence (64%); 48% of patients had a GCS ≤5; 62.1% had a Pediatric Trauma Score (PTS) ≤3 at hospital admission. The mortality rate was 41% (24/58) and most of them (88%; 21/24) died within 48 h. An increased death rate was noted in children admitted with hypoxemia (p = 0.001), low systolic blood pressure (p = 0.002), hypothermia (p = 0.0001), GCS ≤5 (p = 10−5), PTS ≤3 (p = 0.008), hyperglycemia (p = 0.023), coagulation disorders (p = 0.02), and initial intracranial pressure ≥20 mmHg (p = 0.03). Initial hypothermia, hyperglycemia, and coagulation disorders were the only independent predictive factors of mortality.

Conclusion

Severe head injuries resulting from falls from windows carry a high risk of mortality in less than 6-year-old children. Hypothermia, hyperglycemia, and coagulation’s disorders are independent predictive factors of mortality. Early deaths could be considered as direct consequences of uncontrollable brain lesions.

Keywords

Pediatric Fall Head injury Prognosis Mortality 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jose Roberto Tude Melo
    • 1
    • 2
  • Federico Di Rocco
    • 1
  • Laudenor Pereira Lemos-Júnior
    • 2
  • Thomas Roujeau
    • 1
  • Bertrand Thélot
    • 3
  • Christian Sainte-Rose
    • 1
  • Philippe Meyer
    • 4
  • Michel Zerah
    • 1
  1. 1.Department of Pediatric Neurosurgery Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris—France)Université Descartes Paris 5ParisFrance
  2. 2.Post-Graduate Program in Medicine and Health—School of MedicineFederal University of BahiaSalvadorBrazil
  3. 3.Institut National de Veille SanitaireParisFrance
  4. 4.Pediatric Surgical Critical Care Unit, and Anesthesiology, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris—France)Université Descartes Paris 5ParisFrance

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