Severe head injury among children: Prognostic factors and outcome

Aim: To determine predictive factors of mortality among children after traumatic brain injury. Methods: A retrospective study over 8 years of 222 children with severe head injury (Glasgow Coma Scale score <= 8) admitted to a university hospital (Sfax, Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during intensive care unit stay. Results: The study included 163 boys (73.4%) and 59 girls, with mean age 7.54 +/- 3.8 years. The main cause of trauma was road traffic accident (75.7%). Mean Glasgow Coma Scale score was 6 +/- 1.5, mean Injury Severity Score (ISS) was 28.2 +/- 6.9, mean Paediatric Trauma Score (PTS) was 3.7 +/- 2.1 and mean Paediatric Risk of Mortality (PRISM) was 14.3 +/- 8.5; 54 children (24.3%) died. Univariate analysis showed that low PTS on admission, high ISS or PRISM, presence of shock or meningeal haemorrhage or bilateral mydriasis, and serum glucose > 10 mmol l(-1) were associated with mortality rate. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 20 and bilateral mydriasis on admission. Conclusions: In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic accidents. Short-term prognosis is poor, with a high mortality rate (24.3%), and is influenced by demographic, clinical, radiological and biological factors. (C) 2008 Elsevier Ltd. All rights reserved.