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Clinicopathological Study of Pediatric Head Injuries

Associate Professor, Department of Neuro Surgery, Narayana Medical College & Hospital, Chinthareddypalem, Nellore, Andhra Pradesh 524003, India , G. Vidyasagar

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International Journal of Neurology and Neurosurgery 10(3):p 168-174, Jul-Sep 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10318.5

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Abstract

  Aim: Current study aimed to analyze the clinical and radiological presentation of severe head injury in pediatric population and the outcome and their comparison with that of adult severe head injury. Methods: This is a prospective study consisting of 764 children with head injury admitted in the period of 5 year duration. All children under 14yrs of age were included in the study. In all the children variety of clinical and radiological parameters were collected and analyzed Glasgow outcome scale was noted in all these patients at the time of discharge and at the end of 3 months and the outcome is compared with adults with severe head injury. Results: Out of 764 children, 156 had severe head injury. Documentation and analysis of various clinical factors was done and the results were compared, with adults with severe head injury. In this study majority of patients were < 3 yrs old. But incidence of severe head injury was more in the 9­14 yrs age group i.e., 56.4%. In this study, 64% were male children and 35.9% are female children. Most common cause was fall from height 63.35%, followed by RTA 27.2%. In 132 cases managed conservatively, out of which, diffuse brain injury (56), Small SDH (28), Small EDH (24), Contusions (12), SAH (8), Skull fracture (40). Surgery was done for all compound depressed fracture and for significant intracranial hematomas. Thirty children with head injury needed surgical intervention (3.93%). In adults 9.69% (612 out of 6316 admissions) cases were managed surgically. Post­Operative Complications­Wound infection noted in 5 (16.7%), CSF leak in 3 (10%), post­Operative Seizures in 3 (10%), Meningitis in 2 (6.7%) and one patient (3.3%) developed acute hydrocephalus who underwent ventriculoperitoneal shunt. In children with severe head injuries, 20.5% mortality rate was noted and good recovery is noted in 58% at the time of discharge and 64% at the end of 3 months. Conclusions: Good recovery is noted in 58% of children compared to 47% in adults with severe head injury. Poor GCS at presentation, presence of shock, presence of diffuse cerebral edema on CT scan where the factors found to be associated with poor prognosis. Though age less than three years and pupillary abnormality were associated with increased mortality they were not found statistically significant in this series. Most of the accidents and deaths from head injury are preventable, what we need is caution, prevention is the best way to decrease this morbidity.


Keywords: Pediatric Head Injuries; GCS Scale; Mortality

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10318.5

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