Head Trauma in Children, Part 2: Course and Discharge With Outcome

Author:

Kapapa Thomas1,König Kathrin2,Pfister Ulrike3,Sasse Michael4,Woischneck Dieter5,Heissler Hans6,Rickels Eckhard5

Affiliation:

1. Department of Neurosurgery, University of Ulm, Ulm, Germany,

2. Department of Neurosurgery, Krankenhaus Nordstadt, Hannover, Germany

3. Department of Pediatric Medicine, Clementine Hospital, Frankfurt am Main, Germany

4. Department of Pediatric Medicine, Intensive Care Unit, Medizinische Hochschule Hannover, Hannover, Germany

5. Department of Neurosurgery, University of Ulm, Ulm, Germany

6. Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany

Abstract

To minimize the secondary brain damage, we analyzed the effect of cerebral perfusion pressure—orientated management and tried to find factors of clinical management and biochemical findings that influence clinical, cognitive, and psychosocial outcome. Management at intensive care unit was standardized. A standardized (short form 36 health survey) and nonstandardized split questionnaire explored long-term outcome. Glutamic-oxaloacetic-transaminase, creatine kinase MB or glucose are markers for bad outcome (P < .05). Patients with cerebral perfusion pressure values below the recommended standard for just a single occurrence had significantly worse outcome (P = .0132). Mean arterial pressure, central venous pressure, and heart rate alone do not correlate with outcome. At least 1 occurrence of mean arterial pressure and central venous pressure below the lower limits resulted in a poor outcome (P = .035). Cerebral perfusion pressure—guided therapy seems to prevent further brain damage and results in outcome scores that are comparable to those children with head trauma exhibiting symptoms of mild brain edema.

Publisher

SAGE Publications

Subject

Clinical Neurology,Pediatrics, Perinatology, and Child Health

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