gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Clinical course and outcome of 40 children with severe head injury

Kritische Parameter bei Kindern mit schwerem Schädel-Hirn-Trauma

Meeting Abstract

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  • corresponding author A. Sarrafzadeh - Department of Neurosurgery, Charité Campus Virchow-Medical Clinic, Humboldt-University Berlin
  • H. Haberl - Department of Neurosurgery, Charité Campus Virchow-Medical Clinic, Humboldt-University Berlin

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-14.02

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Veröffentlicht: 4. Mai 2005

© 2005 Sarrafzadeh et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.




Head injury is a major cause of death and disability in children. Despite advances in resuscitation and intensive care monitoring, there are few data demonstrating the predictive value of certain physiological variables regarding outcome in this patient population. The purpose of the study was to analyze the clinical course and physiological variables such as cerebral perfusion pressure, oxygenation parameters and cerebral metabolism in relation to surgical interventions (e.g. decompressive surgery) and clinical outcome.


Retrospective study, setting in a neurosurgical intensive care unit. 40 children (mean age 9.5, range 5-16 years) with severe head injury and intracranial pressure monitoring, whose admission Glasgow Coma Scores (GCS) were <8. After admission to the intensive care unit, the following parameters were monitored: mean arterial blood pressure, cerebral perfusion pressure, endtidal CO2, and the GCS. In a subgroup of patients (n=10) brain tissue pO2 (btiO2, Licox) and/or microdialysis was monitored. Hourly analyses of glucose, pyruvate, lactate and glutamate were performed using a bedside device (CMA 600). Outcome was assessed after one year according to the Glasgow Outcome Scale. Admission data and physiological parameters were analyzed for their potential in outcome prediction. Differences were rated significant at p<0.05.


No complication in relation to the insertion of the catheters were observed. Total monitoring time was 9.5 days (6.7 to 14.3 days). 30 children underwent surgical hematoma evacuation (epidural, n=14; subdural, n=13, contusional hemorrhage, n=3). In 8 children, decompressive surgery was performed. Only in 3 of 8 children, normal ptiO2-values were measured, while 2 children had abnormally high btiO2-values (>35 mmHg) and 3 children episodes of cerebral hypoxia (<10 mmHg). Glutamate was pathologically elevated before decompressive surgery. Outcome after 1 year ranged 1-5 (mean 3.8).


In children with severe head injury, monitoring of CPP and metabolism enables to guide an individual therapeutical approach including decompressive surgery. This possibly improves outcome of these patients.