TY  - JOUR
PY  - 2011//
TI  - Severe pediatric head injuries (II): factors associated to morbidity-mortality
JO  - Medicina intensiva
A1  - Valerón Lemaur, M. E.
A1  - López Álvarez, J. M.
A1  - González Jorge, R.
A1  - Morón Saén de Casas, A.
A1  - Consuegra Llapurt, E.
A1  - Jiménez Bravo de Laguna, A.
A1  - Limiñana Cañal, J. M.
A1  - Pérez Quevedo, O.
SP  - 337
EP  - 343
VL  - 35
IS  - 6
N2  - OBJECTIVE: To describe the factors associated to morbidity-mortality in pediatric patients with severe head injury (SHI). MATERIAL AND METHOD: A review was made of the patients admitted to the Pediatric Intensive Care Unit (PICU) with SHI between July 1983 and December 2009. RESULTS: Of the 389 patients with head injuries, 174 (45%) presented SHI. The mean age of these subjects was 67 (9) months, with a Glasgow Coma Score (GCS) of 5.5 (1.8) and a PRISM score of 10.6 (6.7). Thirty-nine percent of the patients showed diffuse encephalic injury (DEI) in the computed tomography (CT) study. Seventy-nine percent of the patients subjected to intracranial pressure monitoring (ICP) presented intracranial hypertension. These patients had a greater incidence of serious sequelae (66.7 vs. 23.1%; p=0.01). Sequelae of clinical relevance were recorded in 59 patients (34%), and proved serious in 64% of the cases. The mortality rate among the patients with SHI was 24.7%, and mortality was significantly associated with a lower GCS score, hyperglycemia, intracranial hypertension and the presence of mydriasis or shock. The mortality rate associated to severe DEI was significantly higher than in the case of mild-moderate DEI (87.5 vs. 7.2%; p<0.001). The independent mortality risk factors in the pediatric patients with SHI were found to be the presence of mydriasis (OR: 31.27), intracranial hypertension (OR: 13.23) and hyperglycemia (OR: 3.10). CONCLUSIONS: a) SHI in pediatric patients was associated with high morbidity-mortality; b) intracranial hypertension was associated to the development of serious sequelae; c) independent mortality risk factors were the existence of mydriasis, intracranial hypertension and hyperglycemia.<p />  <p>Language: es</p>
LA  - es
SN  - 0210-5691
UR  - http://dx.doi.org/10.1016/j.medin.2011.02.006
ID  - ref1
ER  -