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.
Intensive care for pediatric traumatic brain injury / A. Sigurtà, C. Zanaboni, K. Canavesi, G. Citerio, L. Beretta, N. Stocchetti. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 39:1(2013), pp. 129-136.
|Titolo:||Intensive care for pediatric traumatic brain injury|
SIGURTA', ANNA (Corresponding)
ZANABONI, CLELIA (Corresponding)
STOCCHETTI, NINO (Corresponding)
|Parole Chiave:||Cerebral perfusion pressure; Intracranial pressure; Neurotrauma; Outcome; Pediatrics; Adolescent; Brain Injuries; Child; Child, Preschool; Female; Glasgow Coma Scale; Glasgow Outcome Scale; Humans; Infant; Infant, Newborn; Intensive Care; Intracranial Pressure; Length of Stay; Male; Monitoring, Physiologic; Retrospective Studies; Treatment Outcome; Critical Care and Intensive Care Medicine|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||2013|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1007/s00134-012-2748-0|
|Appare nelle tipologie:||01 - Articolo su periodico|