Traumatismo craneoencefálico grave en pacientes pediátricos. Factores pronósticos de mortalidad.

Introduction: Severe head injury is the main cause of traumatic death in the pediatric population and it is responsible for producing severe sequelae, like metal retardation, infantile epilepsy and physical disabilities. Objective: To describe the characteristics of pediatric patients with severe head injury (SHI) and analyzed factors associated with mortality. Material and methods: This is a retrospective, observational and analytic study. We reviewed all patients admitted to the Pediatric Intensive Care Unit (PICU) with SHi, between May 1 of 2004 and May 31 of 2007. Statistics: Patients medical records were retrieved, all patients were separated in two groups: A (alive) and B (dead). Demographic and morbidity and mortality variables were analyzed; odds ratio was determined for those with statistical significance. Results: Of the 506 patients admitted to the PICU, 37 (7.3%) presented SHI. The mean age in this group was 7.2 + 4.4 years, with a mean Glasgow coma scale (GCS) of 7.1 + 2.9. In the CT scan, 40% of the patients presented diffuse brain lesions grade II (DBL) and 37% had DBL grade V, being these two the most common lesions. Clinically important sequelae were found in 8 (26.6%). Mortality in patients with SHI was 20% and was significantly associated with a GCS lower than 5 (p= 0.005), the presence of mydriasis (p= 0.003), lactacidemia (p= 0.006) and hyperglycemia (p= 0.001), as well as having presented cardiac arrest (p= 0.001). Conclusion: Morbidity and mortality in this study group with SHI was similar to that in most published series. A lower GCS score was associated with a higher mortality. Risk factors associated to mortality were the presence of mydriasis, lactacidemia, hyperglycemia and cardiac arrest. [ABSTRACT FROM AUTHOR]