Prognostic risk factors in children with severe heed injuries

Background: Analysis of the impact of head fractures, intracranial hemorrha ges, brain edema, and prognostic risk factors on longterm outcome in childr en with severe head injury. Methods: Retrospective analysis of prognostik risk factors of 150 children after severe head injury (GCCS less than or equal to 8) by univariate and m ultivariate analysis. Results: 150 of 227 children (median age 6.6 years),sustained a severe head injury .92 of them (61.3%) had traffic related injuries. 65 children (43.4 %) had skull fractures, 87 patients (58.0%) an intracranial hemorrhage, and 79 patients (52.7%) a diffuse brain swelling/edema within 72 h after traum a. 33 deaths (22%) were related in most cases to secondary brain swelling/e dema. Children with an initial GCSS<5 had a probability of 18% of survival. 59 children (39.3%) had severe neurological impairments at the time of dis charge. Therapeutic modalities (hyperventilation, mannitol-infusions, dexam ethasone-therapy) showed no significant positive nor negative effects on su rvival. Conclusions: The major risks for death or neurological impairment after sev ere head injury in children are primary areflexia and the development of se condary brain swelling/edema, indicated by a low GCSS (3-5).