DETERMINANTS OF TRAUMATIC BRAIN INJURY OUTCOME IN THE RED CROSS CHILDREN'S HOSPITAL PAEDIATRIC INTENSIVE CARE UNIT

Objectives: This study was performed to ascertain the predictive features of outcome and the efficacy of our interventions with regard to morbidity and mortality.

Methods: A retrospective review of admissions to the Intensive Care Unit from July 2002 to June 2004 was performed. The data gathered included injury modes, times between injuries and points of care, clinical and radiological findings, biochemical parameters and intervention modalities. Outcome was assessed with regards to survival and Paediatric Overall Performance Category.

Results: Of 70 patients included, 73% (n=51) were as a result of pedestrian injuries. 84% (n=59) required ventilation. 19 children (27%) had intracranial pressure monitoring. 80% (n=56) of children survived, with 25% (n=14) left with significant functional disability. Mortality and poor functional outcome were predicted for by the motor score component of the Glasgow Coma Scale (GCS) on admission (OR=0.2, CI 0.06–0.69 and OR 0.24, CI 0.101–0.59 respectively), and by the presence of brain swelling (OR=19, CI 1.5–240 and OR 6, CI 1–37.6 respectively). Poor functional outcome was predicted for by intra-axial haemorrhage (OR=16, CI 2.0–128.0), duration of abnormal consciousness (OR 1.22, CI 1.05–1.42) and lowest recorded Pa CO2 (Median 3.4 KPa, OR 0.46 CI 0.24–0.88). Hypertonic saline was the most commonly employed mode of intracranial pressure modulation (n=28, 40%) with no modality proving significantly superior.

Conclusion: The majority of children survived to discharge with serious disability occurring in a quarter of survivors. The GCS motor score is a useful clinical tool for indicating the severity of a TBI. Duration of abnormal consciousness and intra-axial haemorrhage help to define the risk of later functional disability. Hypocapnia should be avoided. The need to prevent and treat brain swelling is emphasised.