Management of children with severe traumatic brain injury in an adult ICU: evaluation of outcome

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Introduction

Injuries are the leading cause of death in children and brain injury is the most common cause of paediatric traumatic death. Shortage of paediatric intensive care units imposes children's occasional admission in an adult ICU. We attempted to evaluate the effectiveness of their management in a nonspecialised environment (adult ICU).

Methods

Data of 31 children with severe traumatic brain injury (STBI), admitted in our ICU, were reviewed retrospectively. Cases were analysed according to the following criteria: 1) age in years, 2) GCS (upon admission), 3) CT- scan grade, 4) injury severity score (ISS), 5) paediatric trauma score (PTS), 6) paediatric risk of mortality (PRISM III-24 h), 7) length of ICU stay in days and 8) outcome at ICU discharge (Glasgow outcome score -GOS). The demographic data of the studied group are shown in the Table.

Results

1) Mean age was 6.4 years (SD± 5). 2) Traffic-related accidents were responsible for 67.7% (n=21) of cases, 29.1% (n=9) were attributed to fall from height and 3.2% (n=1) to gunshot. 3) The average length of ICU stay was 5.1 days. 4) Eighteen patients (58.1%) fully recovered (GOS 5), 7 patients (22.5%) presented moderate neurological dysfunction (GOS 3-4) and 6 patients (19.4%) had a poor outcome (GOS 1) while predicted mortality according to PRISM III-24h was estimated to be 21.8%. Among those with poor outcome, four cases of brain death due to secondary brain oedema were included. All fatalities were attributed to the severity of injury (Table). 5) In addition to GCS (r=0.78, P<0.01) early hints for poor prognosis were acquired from CT findings (r=-0.84, P<0.01) and PTS (r=0.57, P<0.01).

Conclusion

Despite the adverse environment related to the inherent impediments of an adult ICU, the results of this study are indicative of a rather efficient treatment of children with STBI compared to relative outcome results of specialised paediatric units.

Table Demographic data ^*mean ± SD