Artikel
Severe traumatic brain injury in children: a single-center experience regarding therapy and outcome
Schweres Schädel-Hirn-Trauma bei Kindern
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Autoren
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H.E. Keim
- Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin
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U. W. Thomale
- AB Pädiatrische Neurochirurgie, Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin
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A. S. Sarrafzadeh
- Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: The authors examine the outcome of children with severe traumatic brain injury (TBI) with regard to severity of injury and therapeutic measures, especially decompressive craniectomy (DC) versus conservative therapy, in a single-center pediatric patient population.
Methods: A retrospective review of data was performed on all children (≤16 yrs) with severe TBI on admission or deterioration to a GCS of <9 during hospitalization, admitted between 1994 and 2006. The following data were reviewed: extra/intracranial injuries, intracranial pressure (ICP), decompressive craniectomy (DC) and outcome assessed according to the Glasgow Outcome Score (GOS) at 6 and 12 months.
Results: 53 TBI-patients (mean age 8.0 years, range 0-16 years) were studied. In 14 (26.4%) patients DC was performed 2.3 days (range 0-12 days) post trauma. Mean GCS on admission was 6.6, being lower in children with DC (4.1) compared to those treated conservatively (7.6, p=0.002). Five children underwent early DC (<24 hrs post trauma), of these 4 children survived with a favourable outcome. The remaining children were first treated conservatively including barbiturate coma in 7 cases before DC. Postoperative control of ICP could be achieved in 9 (64.3%) of the patients who required DC. Overall mortality was 9.4% (5 patients) and comparable in both groups. The presence of extracranial injuries (n=25, 47.17%) and scull fractures (n=29, 54.72%) did not affect outcome. Mean GOS at 6 months was 3.5 and tended to be lower in the DC-group (3.1) compared to the Non-DC-group (3.7, p=0.076). A high ICP (>40mmHg) before DC and episodes of ICP >20mmHg after DC were indicators of poor outcome.
Conclusions: Though children who underwent decompressive surgery were more severely injured, the outcome differed only slightly to patients treated conservatively. In our view, decompressive craniectomy is a good option in pediatric TBI patients to control ICP. Though due to the small number of cases an advantage of primary DC could not be shown, early decompressive craniectomy might be favoured in this TBI population.
