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Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry.

Lichte P, Andruszkow H, Kappe M, Horst K, Pishnamaz M, Hildebrand F, Lefering R, Pape HC, Kobbe P, TraumaRegister D - Eur. J. Med. Res. (2015)

Bottom Line: On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury.Nevertheless, we were able to demonstrate marked differences of outcome.But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. plichte@ukaachen.de.

ABSTRACT

Background: In the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in-hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy.

Methods: We performed a retrospective analysis of the TraumaRegister DGU(®) from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1-3, 4-6, 7-10, 11-14, 15-17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ failure, and mortality. Additionally, the Glasgow Outcome Scale (GOS) at discharge was observed.

Results: Overall, 1110 children and 6491 adult control patients were included. Comparing the rate of intubation on-scene, the rate of cranial CT scans, the rate of craniotomies, and the rate and length of intensive care treatment, we could only identify minor differences between the age groups. The treatment after discharge from hospital was markedly different due to a very low rate of in-patient rehabilitation treatment in children. On one hand, the rate of systemic complications, such as sepsis and multiple organ failure increased with increasing age. On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury. The in-hospital functional outcome in survivors, according to the GOS, was beneficial for younger children in comparison to adolescents and adults.

Conclusions: We were unable to identify marked age-related differences in the therapeutic approach. Nevertheless, we were able to demonstrate marked differences of outcome. Children younger than 7 years significantly die more often due to direct impact of severe trauma. But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.

No MeSH data available.


Related in: MedlinePlus

In-hospital mortality rate according to the AIS head. After very severe TBI, the mortality rate is significantly higher in children younger than 6 years compared to the older children (*p = 0.001), adolescents (#p = 0.001), and also adults ($p < 0.001)
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Fig1: In-hospital mortality rate according to the AIS head. After very severe TBI, the mortality rate is significantly higher in children younger than 6 years compared to the older children (*p = 0.001), adolescents (#p = 0.001), and also adults ($p < 0.001)

Mentions: Overall, the mortality rates showed differences between the different age groups (p = 0.004). Interestingly, we observed a higher mortality in children younger than 7 years in comparison to older children and adults (Table 4), especially after very severe TBI (AIS head = 5: 17.1 vs. 9.5 %, p = 0.001) (Fig. 1). On the other hand, in survivors, the functional outcome according to the GOS was better in younger patients: the overall percentage of patients with a low disability at discharge decreased with increasing age, and the rate of severe disabilities increased simultaneously. These differences were, again, most obvious in patients with very severe brain injury (AIS head = 5) (Fig. 2). Likewise, the length of ICU and hospital stay, as well as the days of mechanical ventilation accelerated with increasing age. Additionally, we evaluated a lower rate of systemic complications (sepsis, MOF) in children younger than 14 years in comparison to adolescents and adults.Table 4


Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry.

Lichte P, Andruszkow H, Kappe M, Horst K, Pishnamaz M, Hildebrand F, Lefering R, Pape HC, Kobbe P, TraumaRegister D - Eur. J. Med. Res. (2015)

In-hospital mortality rate according to the AIS head. After very severe TBI, the mortality rate is significantly higher in children younger than 6 years compared to the older children (*p = 0.001), adolescents (#p = 0.001), and also adults ($p < 0.001)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536600&req=5

Fig1: In-hospital mortality rate according to the AIS head. After very severe TBI, the mortality rate is significantly higher in children younger than 6 years compared to the older children (*p = 0.001), adolescents (#p = 0.001), and also adults ($p < 0.001)
Mentions: Overall, the mortality rates showed differences between the different age groups (p = 0.004). Interestingly, we observed a higher mortality in children younger than 7 years in comparison to older children and adults (Table 4), especially after very severe TBI (AIS head = 5: 17.1 vs. 9.5 %, p = 0.001) (Fig. 1). On the other hand, in survivors, the functional outcome according to the GOS was better in younger patients: the overall percentage of patients with a low disability at discharge decreased with increasing age, and the rate of severe disabilities increased simultaneously. These differences were, again, most obvious in patients with very severe brain injury (AIS head = 5) (Fig. 2). Likewise, the length of ICU and hospital stay, as well as the days of mechanical ventilation accelerated with increasing age. Additionally, we evaluated a lower rate of systemic complications (sepsis, MOF) in children younger than 14 years in comparison to adolescents and adults.Table 4

Bottom Line: On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury.Nevertheless, we were able to demonstrate marked differences of outcome.But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Trauma Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. plichte@ukaachen.de.

ABSTRACT

Background: In the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in-hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy.

Methods: We performed a retrospective analysis of the TraumaRegister DGU(®) from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1-3, 4-6, 7-10, 11-14, 15-17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ failure, and mortality. Additionally, the Glasgow Outcome Scale (GOS) at discharge was observed.

Results: Overall, 1110 children and 6491 adult control patients were included. Comparing the rate of intubation on-scene, the rate of cranial CT scans, the rate of craniotomies, and the rate and length of intensive care treatment, we could only identify minor differences between the age groups. The treatment after discharge from hospital was markedly different due to a very low rate of in-patient rehabilitation treatment in children. On one hand, the rate of systemic complications, such as sepsis and multiple organ failure increased with increasing age. On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury. The in-hospital functional outcome in survivors, according to the GOS, was beneficial for younger children in comparison to adolescents and adults.

Conclusions: We were unable to identify marked age-related differences in the therapeutic approach. Nevertheless, we were able to demonstrate marked differences of outcome. Children younger than 7 years significantly die more often due to direct impact of severe trauma. But if they survive, they seem to develop less systemic complications and profit from a better functional outcome.

No MeSH data available.


Related in: MedlinePlus