Risk factors for mortality within first 24 hours of head injury

Abstract

Objective Immediate or instantaneous death following cranial trauma occurs due to unpreventable primary brain insults. However, death occurring within 24 hours of head injury can be averted by timely institution of the therapeutic measures that could prevent secondary brain insults. From the management point of view, this is the most important subset of all head injured patients. Therefore, it is important to study risk factors associated with such deaths.Methods: In a retrospective study undertaken at Trauma Center, Safdarjang Hospital, New Delhi, the demographic characteristics, neurological and radiological findings were studied for 100 head injured children admitted in the pediatric surgical ward, who later died after surviving the initial neurosurgical resuscitation. Death occurring within first 24 hours of head injury was defined as “early “death; and “late death”, if it occurred thereafter.Results: Bivariate analysis revealed the severity of head injury GCS<=8(OR:3.09;95%CI:1.22–7.8), a finding of diffuse brain edema, (OR: 3.73; 95% CI : 0.95-14.74), midline shift (OR:4.8; 95% CI: 1.03-22.37) on cranial CT scans were found to be statistically associated with early deaths. Child’s age or gender, the mode of injury and the presence of extracerebral injuries were not found to be significantly associated. When these variables were simultaneously considered in a multivariate logistic regression model, the diffuse brain edema on head CT scan was found to be both clinically and statistically significant of early death (Adj. OR : 527;95% CI : 1.23-22.6). However, absence of hemorrhagic contusion was clinically important predictor of an early death (Adj. OR : 6.45;95% CI : 0.68.-62.5) though not statistically significant due to a small number of study subjects in this group.Conclusion : Findings of this study could serve as useful guideline in identifying the subset of head injured children for urgent institution of preventive measures.