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[Severe pediatric head injuries (II): factors associated to morbidity-mortality].

Abstract：

OBJECTIVE:To describe the factors associated to morbidity-mortality in pediatric patients with severe head injury (SHI). MATERIAL AND METHOD:A review was made of the patients admitted to the Pediatric Intensive Care Unit (PICU) with SHI between July 1983 and December 2009. RESULTS:Of the 389 patients with head injuries, 174 (45%) presented SHI. The mean age of these subjects was 67 (9) months, with a Glasgow Coma Score (GCS) of 5.5 (1.8) and a PRISM score of 10.6 (6.7). Thirty-nine percent of the patients showed diffuse encephalic injury (DEI) in the computed tomography (CT) study. Seventy-nine percent of the patients subjected to intracranial pressure monitoring (ICP) presented intracranial hypertension. These patients had a greater incidence of serious sequelae (66.7 vs. 23.1%; p=0.01). Sequelae of clinical relevance were recorded in 59 patients (34%), and proved serious in 64% of the cases. The mortality rate among the patients with SHI was 24.7%, and mortality was significantly associated with a lower GCS score, hyperglycemia, intracranial hypertension and the presence of mydriasis or shock. The mortality rate associated to severe DEI was significantly higher than in the case of mild-moderate DEI (87.5 vs. 7.2%; p<0.001). The independent mortality risk factors in the pediatric patients with SHI were found to be the presence of mydriasis (OR: 31.27), intracranial hypertension (OR: 13.23) and hyperglycemia (OR: 3.10). CONCLUSIONS:a) SHI in pediatric patients was associated with high morbidity-mortality; b) intracranial hypertension was associated to the development of serious sequelae; c) independent mortality risk factors were the existence of mydriasis, intracranial hypertension and hyperglycemia.

journal_name

Med Intensiva

journal_title

Medicina intensiva

authors

López Álvarez JM,Valerón Lemaur ME,Pérez Quevedo O,Limiñana Cañal JM,Jiménez Bravo de Laguna A,Consuegra Llapurt E,Morón Saén de Casas A,González Jorge R

doi

10.1016/j.medin.2011.02.006

subject

Has Abstract

pub_date

2011-08-01 00:00:00

pages

337-43

issue

6

eissn

0210-5691

issn

1578-6749

pii

S0210-5691(11)00052-0

journal_volume

35

pub_type

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