Prognostic factors in children with severe diffuse brain injuries: A studyof 74 patients

Severe diffuse brain injury in children has a devastating influence on thei r physical and psychological development. This retrospective study was unde rtaken to analyse the factors that influence outcome in children with such injuries. The short-term outcomes (Glasgow outcome score) of 74 children (a ge less than or equal to 15 years) with severe diffuse brain injury and no focal operable mass lesions on CT scan, admitted between 1992 and 1998 at t he National Institute of Mental Health and Neurosciences were analysed. The prognostic factors analysed were age, gender, time after injury to admissi on, nature of injury, highest post-resuscitation Glasgow coma score (GCS), pupillary reaction, horizontal oculocephalic reflex and CT scan findings. T he following factors were found to be independent predictors of poor outcom e: GCS 3-5 (p < 0.003), absent verbal response (p < 0.001), motor response score of 1-3 (p < 0.001), absent pupillary reaction (p < 0.001), absent ocu locephalic reflex (p < 0.001) and presence of traumatic subarachnoid haemor rhage on CT scan (p < 0.002). These independent variables were then subject ed to a stepwise logistic regression analysis, and the most important varia bles for predicting outcome were oculocephalic reflex and GCS, which togeth er correctly predicted unfavourable outcome with a sensitivity of 79% and a specificity of 65%, An early CT scan or a single CT scan did not have any prognostic significance. Copyright (C) 2001 S. Karger AG,Basel.