Early prediction of neurological outcome after falls in children: metabolic and clinical markers

Falls are the foremost reason for non-fatal injuries and are second only to motor vehicle accidents in causing accidental death. The purpose of this s tudy was to identify the clinical and metabolic predictors of the outcome o f head injury caused by falls from a height. Medical records of 61 children who had been admitted to the paediatric inte nsive care unit from 1990 to 1993 after falling from a height were reviewed retrospectively. Outcomes were categorised as good, moderate, severe, and poor. Glasgow coma scores, pupillary responses, brain oedema, and midline s hift are significantly associated with poor outcome (p<0.05). Metabolic mar kers associated with poor outcome included hyperglycaemia and hypokalaemia. Children with a poor outcome had, at admission, significantly higher gluco se concentrations compared with children with good outcomes (mean (SD): 20. 0 (7.1) v 9.31 (4.0) mmol/l, p<0.01), and lower potassium concentrations co mpared with children with good, moderate, and severe outcomes (mean (SD): 2 .8 (0.4) v 3.7 (0.4) mmol/l, p<0.001, 3.5 (0.3) mmol/l, p<0.01, and 3.41 (0 .3) mmol/l, p<0.05, respectively). These findings allow for an early allocation of effort and resources to chi ldren injured from such falls.