Epidemiology and early predictive factors of outcome in children with severe head injury

Background

Severe traumatic brain injurie (TBI), defined by a GCS ≤ 8, is quite rare in children but carries a high risk of mortality and bad outcome. Early recognition of factors predicting outcome is important for quality assessment and could contribute to a more selective management of the most severe injuries.

Objective

To describe a large population of children with severe TBI admitted to a level I Pediatric Regional Trauma Center with a standardized protocol of care, and identify early predictors of their outcome.

Materials and methods

We retrospectively analyzed the data of a trauma data bank, including, over a 9 years period, all the children (1 month–15 years) with severe TBI (GCS ≤ 8). All these children were followed until death or for at least a 6 months period after discharge. Univariate and further multivariate analyses were performed to determine independent predictive factors of death, outcome at discharge and 6 months later. Receiver Operating Characteristic (ROC) curves were used to determine the threshold values of independent predictors of death or outcome.

Results

Analysis concerned 585 children, 67% were boys, 33% were girls. Mean age was 7 ± 5 years. Mean values for GCS, PTS and ISS were respectively 6 (3–8), 3 (–4 to +10) and 28 (4–75). Mortality rate was 22.4%, GOS was < 3 in 53% of the cases at discharge and 60% at 6 months. Multivariate analysis identified GCS, ISS and initial collapsus as independent predictors of death, bad outcome at discharge and at 6 months. Threshold values for death were 28 for ISS and 6 for GCS. The same values were found for bad outcome, except for outcome at 6 months where threshold value for GCS was 5.

Conclusion

Initial collapsus, GCS, and ISS are independent predictors of outcome in children with TBI. Threshold values can be calculated for predicting bad outcome. These variables can be easily and early detected in this population and used for quality assessment.