Introduction: Traumatic brain injury, from accidental and non-accidental (NAHI) (shaken infant syndrome) causes, is the commonest cause of death and long term morbidity in children. If surviving to reach hospital, it is generally accepted that preventing secondary brain damage is likely to be more efficacious than pharmacological intervention. Therefore the detection and correction of secondary insults remains paramount, and may improve the neurological outcome of patients, but has never been adequately studied in children. Definitions of 'insults' in children are not yet established, so this on-going study aims to determine the total burden of physiological 'derangement' encountered during the patients stay in Intensive Care, and investigate the contribution that makes to global outcome in survivors, and neuropathological findings in non-survivors.
Methods: A 2-year prospective study where physiological data, downloaded every minute from bedside monitors in ICU, is summarised using predetermined thresholds of each physiological variable by age. A Kings Outcome Score of Childhood Head Injury (KOSCHI) at 6 and 12 months post-injury is obtained by questionnaire.
Results: 26 children with severe or moderate HI have been recruited to date as follows: 15 males & 11 females; Age range 4 months - 14.5 years. Causes include 10 pedestrians, 5 falls, 4 RTAs, 3 struck on head and 2 NAHI; Paediatric Trauma Score range 2-10; 1 child had fixed and dilated pupils on admission; 4/26 (15%) have died, and at 6 months 1,3 & 3 have been classified as KOSCHI 3,4 and 5 respectively (11 not yet due). 17/26 had ICP monitoring, the duration of which has ranged from 474 to 17,133 minutes (median 7968, IQ range 3174, 12188). No child has had SvO2 monitored continuously.
Conclusions: Age-specific derangements have been found in all variables, and to date no child has been totally 'derangement-free'. As more patients are recruited, outcome and neuropathology will be analysed in relation to derangement, and it is anticipated that age-specific treatment thresholds may be identified.
Jones PA, Lo TYM, Chambers IR, Wilson G, Mendelow AD, Forsyth R, Fulton B, Andrews PJD, Minns RA. Edinburgh-Newcastle Study: secondary insults after accidental and non-accidental brain injury in children, and relationship to outcome - work in progress. European Journal of Neurosurgery 2002; 144: A19.
Dr. Iain R. Chambers, Cleveland Unit, Middlesbrough. Tel: +44 (0)1642-854-778.
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