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



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.


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.


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.


Pediatric Fall Head injury Prognosis Mortality 


  1. 1.
    Orliaguet GA, Meyer PG, Blanot S, Jarreau MM, Charron B, Buisson C, Carli PA (1998) Predictive factors of outcome in severely traumatized children. Anesth Analg 87(3):537–542PubMedCrossRefGoogle Scholar
  2. 2.
    Gaillard M, Herve C, Reynaud P, Petit JL (1989) Epidemiology of severe cranial injuries in children and the prognosis of injured patients hospitalized in neurosurgery units. Ann Pediatr (Paris) 36(3):194–198Google Scholar
  3. 3.
    Masson F, Salmi LR, Maurette P, Dartigues JF, Vecsey J, Garros B, Erny P (1996) Characteristics of head trauma in children: epidemiology and a 5-year follow-up. Arch Pediatr 3(7):651–660PubMedCrossRefGoogle Scholar
  4. 4.
    Meyer P, Ducrocq S, Baugnon T, Thelot B, Orliaguet G, Carli P, Renier D (2006) Head injury in children less than 2 years of age. Arch Pediatr 13(6):737–740PubMedCrossRefGoogle Scholar
  5. 5.
    Thelot B, Rigou A, Bonaldi C, Ricard C, Meyer P (2006) Epidemiology of accidental falls from heights among children, Paris Region, May to September 2005. Sante Publique 18(4):523–532PubMedCrossRefGoogle Scholar
  6. 6.
    Tursz A, Lelong N, Crost M (1990) Home accidents to children under 2 years of age. Paediatr Perinat Epidemiol 4(4):408–421PubMedCrossRefGoogle Scholar
  7. 7.
    Meyer PG, Thelot B, Baugnon T, Ricard C (2007) The epidemiology of pediatric falls from heights. Pediatr Surg Int 23(1):95–96PubMedCrossRefGoogle Scholar
  8. 8.
    Jennett B (1975) Outcome of severe damage to the central nervous system. Scale, scope and philosophy of the clinical problem. Ciba Found Symp 34:3–21PubMedGoogle Scholar
  9. 9.
    Tentillier E, Dupont M, Thicoipe M, Petitjean ME, Sztark F, Lassie P, Masson F, Dabadie P (2004) Protocol for advanced prehospital emergency care of severe head injury. Ann Fr Anesth Reanim 23(2):109–115PubMedGoogle Scholar
  10. 10.
    Bardella IJ (1999) Pediatric advanced life support: a review of the AHA recommendations. American Heart Association. Am Fam Physician 60(6):1743–1750PubMedGoogle Scholar
  11. 11.
    Laird AM, Miller PR, Kilgo PD, Meredith JW, Chang MC (2004) Relationship of early hyperglycemia to mortality in trauma patients. J Trauma 56(5):1058–1062PubMedCrossRefGoogle Scholar
  12. 12.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242(6):824–828PubMedCrossRefGoogle Scholar
  13. 13.
    Danzl D (2002) Hypothermia. Semin Respir Crit Care Med 23(1):57–68PubMedCrossRefGoogle Scholar
  14. 14.
    Grinkeviciute DE, Kevalas R, Matukevicius A, Ragaisis V, Tamasauskas A (2008) Significance of intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic brain injury. Medicina (Kaunas) 44(2):119–125Google Scholar
  15. 15.
    Trabold F, Meyer PG, Blanot S, Carli PA, Orliaguet GA (2004) The prognostic value of transcranial Doppler studies in children with moderate and severe head injury. Intensive Care Med 30(1):108–112PubMedCrossRefGoogle Scholar
  16. 16.
    Ducrocq SC, Meyer PG, Orliaguet GA, Blanot S, Laurent-Vannier A, Renier D, Carli PA (2006) Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatr Crit Care Med 7(5):461–467PubMedCrossRefGoogle Scholar
  17. 17.
    Grinkeviciute DE, Kevalas R, Saferis V, Matukevicius A, Ragaisis V, Tamasauskas A (2007) Predictive value of scoring system in severe pediatric head injury. Medicina (Kaunas) 43(11):861–869Google Scholar
  18. 18.
    Marcoux KK (2005) Management of increased intracranial pressure in the critically ill child with an acute neurological injury. AACN Clin Issues 16(2):212–231PubMedCrossRefGoogle Scholar
  19. 19.
    Orliaguet GA, Meyer PG, Baugnon T (2008) Management of critically ill children with traumatic brain injury. Paediatr Anaesth 18(6):455–461PubMedCrossRefGoogle Scholar
  20. 20.
    Benoit R, Watts DD, Dwyer K, Kaufmann C, Fakhry S (2000) Windows 99: a source of suburban pediatric trauma. J Trauma 49(3):477–481PubMedCrossRefGoogle Scholar
  21. 21.
    Coats B, Margulies SS (2008) Potential for head injuries in infants from low-height falls. J Neurosurg Pediatr 2(5):321–330PubMedCrossRefGoogle Scholar
  22. 22.
    Lallier M, Bouchard S, St-Vil D, Dupont J, Tucci M (1999) Falls from heights among children: a retrospective review. J Pediatr Surg 34(7):1060–1063PubMedCrossRefGoogle Scholar
  23. 23.
    Melo JR, de Santana DL, Pereira JL, Ribeiro TF (2006) Traumatic brain injury in children and adolescents at Salvador City, Bahia, Brazil. Arq Neuropsiquiatr 64(4):994–996PubMedGoogle Scholar
  24. 24.
    Wu X, Hu J, Zhuo L, Fu C, Hui G, Wang Y, Yang W, Teng L, Lu S, Xu G (2008) Epidemiology of traumatic brain injury in eastern China, 2004: a prospective large case study. J Trauma 64(5):1313–1319PubMedCrossRefGoogle Scholar
  25. 25.
    Meningaud JP, Bertrand JC, Batista D (2003) Maxillofacial trauma by defenestration: 64 cases. Rev Stomatol Chir Maxillofac 104(5):260–264PubMedGoogle Scholar
  26. 26.
    Nguyen-Thanh Q, Tresallet C, Langeron O, Riou B, Menegaux F (2003) Polytrauma is more severe after a free fall from a height than after a motor vehicle accident. Ann Chir 128(8):526–529PubMedCrossRefGoogle Scholar
  27. 27.
    Beigelman-Aubry C, Baleato S, Le GM, Brun AL, Grenier P (2008) Chest trauma: spectrum of lesions. J Radiol 89(11 Pt 2):1797–1811PubMedCrossRefGoogle Scholar
  28. 28.
    Combes P, Fauvage B, Colonna M, Passagia JG, Chirossel JP, Jacquot C (1996) Severe head injuries: an outcome prediction and survival analysis. Intensive Care Med 22(12):1391–1395PubMedCrossRefGoogle Scholar
  29. 29.
    Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A (2003) Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma 54(2):312–319PubMedCrossRefGoogle Scholar
  30. 30.
    Tentillier E, Ammirati C (2000) Prehospital management of patients with severe head injuries. Ann Fr Anesth Reanim 19(4):275–281PubMedGoogle Scholar
  31. 31.
    Rouxel JP, Tazarourte K, Le MS, Ract C, Vigue B (2004) Medical prehospital rescue in head injury. Ann Fr Anesth Reanim 23(1):6–14PubMedCrossRefGoogle Scholar
  32. 32.
    Ricard-Hibon A, Marty J (2000) Management of severe head-injured patients in the first 24 hours. Resuscitation and initial diagnostic strategy. Ann Fr Anesth Reanim 19(4):286–295PubMedGoogle Scholar
  33. 33.
    az-Parejo P, Stahl N, Xu W, Reinstrup P, Ungerstedt U, Nordstrom CH (2003) Cerebral energy metabolism during transient hyperglycemia in patients with severe brain trauma. Intensive Care Med 29(4):544–550Google Scholar
  34. 34.
    Bochicchio GV, Sung J, Joshi M, Bochicchio K, Johnson SB, Meyer W, Scalea TM (2005) Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma 58(5):921–924PubMedCrossRefGoogle Scholar
  35. 35.
    Bochicchio GV, Joshi M, Bochicchio KM, Pyle A, Johnson SB, Meyer W, Lumpkins K, Scalea TM (2007) Early hyperglycemic control is important in critically injured trauma patients. J Trauma 63(6):1353–1358PubMedCrossRefGoogle Scholar
  36. 36.
    Chiaretti A, de Benedicts R, Langer A, Di Rocco C, Bizzarri C, Iannelli A, Polidori G (1998) Prognostic implications of hyperglycaemia in paediatric head injury. Childs Nerv Syst 14(9):455–459PubMedCrossRefGoogle Scholar
  37. 37.
    Jeremitsky E, Omert LA, Dunham CM, Wilberger J, Rodriguez A (2005) The impact of hyperglycemia on patients with severe brain injury. J Trauma 58(1):47–50PubMedCrossRefGoogle Scholar
  38. 38.
    Cochran A, Scaife ER, Hansen KW, Downey EC (2003) Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma 55(6):1035–1038PubMedCrossRefGoogle Scholar
  39. 39.
    Hirsch IB (2002) In-patient hyperglycemia—are we ready to treat it yet? J Clin Endocrinol Metab 87(3):975–977PubMedCrossRefGoogle Scholar
  40. 40.
    Harhangi BS, Kompanje EJ, Leebeek FW, Maas AI (2008) Coagulation disorders after traumatic brain injury. Acta Neurochir (Wien) 150(2):165–175CrossRefGoogle Scholar
  41. 41.
    Kuo JR, Chou TJ, Chio CC (2004) Coagulopathy as a parameter to predict the outcome in head injury patients—analysis of 61 cases. J Clin Neurosci 11(7):710–714PubMedCrossRefGoogle Scholar
  42. 42.
    Fourcade O, Fuzier R, Daboussi A, Gigaud M, Tremoulet M, Samii K (2006) Decompressive craniectomy and intracranial hypertension. Ann Fr Anesth Reanim 25(8):858–862PubMedGoogle Scholar
  43. 43.
    Jagannathan J, Okonkwo DO, Dumont AS, Ahmed H, Bahari A, Prevedello DM, Jane JA Sr, Jane JA Jr (2007) Outcome following decompressive craniectomy in children with severe traumatic brain injury: a 10-year single-center experience with long-term follow up. J Neurosurg 106(4 Suppl):268–275PubMedGoogle Scholar
  44. 44.
    Lescot T, Abdennour L, Degos V, Boch AL, Puybasset L (2007) Management of severe traumatic brain injury. Presse Med 36(7–8):1117–1126PubMedCrossRefGoogle Scholar

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

Personalised recommendations