Child's Nervous System

, Volume 27, Issue 4, pp 583–590 | Cite as

Treatment and outcomes for pediatric head injuries in Mississippi

  • William Hanigan
  • Christina Giurintano
  • Craig Hallstrom
  • Frances Spinosa
  • Domenic Esposito
  • Andrew Parent
  • Warren May
Original Paper
  • 132 Downloads

Abstract

Object

This report summarizes the treatments and outcomes of a large series of patients with pediatric head injuries (PHIs), who were admitted to a tertiary pediatric trauma center at the University of Mississippi Medical Center from January 1, 2003 through December 31, 2006.

Methods

Data were retrieved from the Department of Neurosurgery’s Brain Trauma Registry (BTR) on patients who are ≤16 years old. Data include Glasgow Coma Scale (GCS) and injury severity scores (ISS) on admission and Glasgow Outcome Scale (GOS) scores at 6 months follow-up.

Results

The BTR registered 554 patients with accidental and nonaccidental PHIs. Follow-up was complete in 98.2%. Aggressive first-tier management with ventricular drainage was used to lower intracranial pressure. Vasopressors were used only to correct hypotension. Second-tier therapies were used infrequently. Craniectomies (14 patients) were associated with good outcomes (GOS 4–5) in nine patients; hypothermia (six patients) and barbiturate (four patients) therapies were ineffective. All 439 patients with ISS <25 showed good outcomes. Fifteen of 16 patients with GCS >8 and ISS ≥25 had good outcomes. In 134 patients with severe PHIs (GCS ≤8), all 45 with ISS <25 and 46 with ISS ≥25 showed good outcomes. Forty-three patients with GCS ≤8 and ISS ≥25 had poor outcomes. Of these patients, 38 died; 22 died within 3 days of admission.

Conclusions

This study indicated that poor outcomes occurred only in PHIs with severe generalized trauma. While 28.4% of patients with GSC ≤8 died, more than half of these sustained nonsurvivable injuries. Aggressive medical management with ventricular drainage was the mainstay of therapy.

Keywords

Pediatric head injuries Treatment Trauma registry 

Notes

Acknowledgement

The authors wish to acknowledge the pediatric intensivists, attending surgeons, and nursing personnel in the pediatric ICU for their dedication to the care of children with head injuries. The authors also wish to thank Laura Day and Carolyn Wilson for secretarial assistance.

Conflicts of interest

The authors have no commercial or proprietary interests in any drug, device, or equipment mentioned in this article.

References

  1. 1.
    Adelson PD, Bratton SL, Carney MA et al (2003) Critical pathway for the treatment of established intracranial hypertension in pediatric traumatic brain injury. Pediatr Crit Care Med 4(3 Supplement):S65–S67PubMedGoogle Scholar
  2. 2.
    Athens AB, Fantus RJ (2008) NTDB National Trauma Data Bank 2008. Pediatric report version 8.0. American College of Surgeons, ChicagoGoogle Scholar
  3. 3.
    Borse NN, Gilchrist J, Dellinger AM et al (2008) CDC childhood injury report: patterns of unintentional injuries among 0- to 19-year-olds in the United States, 2000–2006. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, AtlantaGoogle Scholar
  4. 4.
    Contant CF Jr, Narayan RK (1996) Prognosis after head injury. In: Yumans YR (ed) Neurological surgery, 4th edn. W.B. Saunders, Philadelphia, pp 1792–1812Google Scholar
  5. 5.
    Diggs BS, Mullins RJ, Hedges JR et al (2008) Proportion of seriously injured patients admitted to hospitals in the U.S. with a high annual injured patient volume: a metric of regionalized trauma care. J Am Coll Surg 206:212–219PubMedCrossRefGoogle Scholar
  6. 6.
    Forbes ML, Adelson PD, Kochanek PM (2008) Critical care management of traumatic brain injury. In: Albright AL, Pollack IF, Adelson PD (eds) Principles and practice of pediatric neurosurgery, 2nd edn. Thieme, New York, pp 833–847Google Scholar
  7. 7.
    Fortune JB, Feustel PJ, Garca L et al (1995) Affect of hyperventilation, mannitol and ventriculostomy drainage on cerebral blood flow after head injury. J Trauma 39:1091–1099PubMedCrossRefGoogle Scholar
  8. 8.
    Ghajar J, Hariri RJ (1992) Management of pediatric head injury. Pediatr Clin North Am 39:1093–1125PubMedGoogle Scholar
  9. 9.
    Hanigan W, Esposito D, Spinosa F et al (2009) Development, funding, and effectiveness of a trauma system for pediatric head injuries (PHIs) in Mississippi. AANS Neurosurgeon, in pressGoogle Scholar
  10. 10.
    Hutchison J, Ward RE, Lacroix J et al (2008) Hypothermia therapy after traumatic brain injury in children. New Engl J Med 358:2447–2456PubMedCrossRefGoogle Scholar
  11. 11.
    Jagannathan J, Okonkwo DO, Yeoh HK et al (2008) Long-term outcomes and prognostic factors in pediatric patients, with severe traumatic brain injury and elevated intracranial pressure. J Neurosurg Pediatr 2:240–249PubMedCrossRefGoogle Scholar
  12. 12.
    Jennet B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–481CrossRefGoogle Scholar
  13. 13.
    Krause JF (1995) Epidemiological features of brain injury in children: occurrence, children at risk, causes and manner of injury, severity, and outcome. In: Broman SH, Michel ME (eds) Traumatic head injury in children. Oxford University Press, New York, pp 22–39Google Scholar
  14. 14.
    Langlois GA (2000) Traumatic brain injury in the United States: assessing outcomes in children summary and recommendations from the Expert Working Group, Division of Acute Care, Rehabilitation Research and Disability Prevention. National Center for Injury Prevention and Control, Department of Health and Human Services, Centers for Disease Control and Prevention. Atlanta, GA, October 26–27Google Scholar
  15. 15.
    Mann NC, Mullins RJ, Hedges JR et al (2001) Mortality among seriously injured patients treated in remote rural trauma centers before and after implementation of a statewide trauma system. Med Care 39:643–653CrossRefGoogle Scholar
  16. 16.
    Marmarou A (2001) The American brain injury consortium. In: Miller LP, Hayes RL, Newcomb JK (eds) Head trauma: basic, preclinical, and clinical directions. Wiley, New Jersey, pp 371–384Google Scholar
  17. 17.
    Michaud LJ, Rivara FP, Grady MS et al (1992) Predictors of survival and severity of disability after severe brain injury in children. Neurosurg On-Line 31:254–264Google Scholar
  18. 18.
    Moraine JJ, Berre J, Melot C (2000) Is cerebral perfusion pressure a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions? J Neurosurg 92:606–614PubMedCrossRefGoogle Scholar
  19. 19.
    Pollack MM, Ruttimann UE, Getson PR (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116PubMedCrossRefGoogle Scholar
  20. 20.
    Reid SR, Roesler JS, Gaiches AM et al (2001) The epidemiology of pediatric traumatic brain injury in Minnesota. Arch Pediatr Adolesc Med 155:784–789PubMedGoogle Scholar
  21. 21.
    Teasdale G, Jennett B (1976) Assessment and prognosis after head injury. Acta Eurochir (Wien) 34:45–55CrossRefGoogle Scholar
  22. 22.
    Thurman DJ, Alverson C, Browne D et al (1999) Traumatic brain injury in the United States: a report to congress. Division of Acute Care, Rehabilitation Research, and Disability Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, AtlantaGoogle Scholar
  23. 23.
    Thurman DJ, Alverson C, Dunn KA et al (1999) Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil 14:602–615PubMedCrossRefGoogle Scholar
  24. 24.
    Van Natta TL, Morris JA Jr (2000) Injury scoring and trauma outcomes. In: Mattox KL, Feliciano DV, Moore EE (eds) Trauma, 4th edn. McGraw-Hill, New York, pp 69–78Google Scholar
  25. 25.
    Van Natta TL, Morris JA Jr (2000) Injury scoring and trauma outcomes. In: Mattox KL, Feliciano DV, Moore EE (eds) Trauma, 4th edn. McGraw-Hill, New York, p 72, Fig. 5-2Google Scholar
  26. 26.
    Vigue B, Ract C, Benayed M et al (1999) Early SjvO2 monitoring in patients with severe brain trauma. Intensive Care Med 25:445–451PubMedCrossRefGoogle Scholar
  27. 27.
    White JRM, Farukhi Z, Bull C et al (2001) Predictors of outcome in severely head-injured children. Crit Care Med 29:534–540PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • William Hanigan
    • 1
  • Christina Giurintano
    • 2
  • Craig Hallstrom
    • 3
  • Frances Spinosa
    • 1
  • Domenic Esposito
    • 1
  • Andrew Parent
    • 1
  • Warren May
    • 4
  1. 1.Department of NeurosurgeryUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.SOM, University of Mississippi Medical CenterJacksonUSA
  3. 3.Department of PediatricsUniversity of Mississippi Medical CenterJacksonUSA
  4. 4.Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA

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