Factors affecting outcome in children with head injury: a tertiary care centre study

Abstract

Abstract: Aim and objective: To investigate various prognostic factors associated and their effect on the neurological outcome among children with a head injury on the basis of mode of injury, GCS at time of admission, pupillary response, hypoxia, CT scan findings and time of surgical intervention. Methods: This was a prospective observational study of thirty-four children (age <15 years) with a head injury, managed in the P.G. Department of surgery, S.R.N. Hospital associated with M.L.N Medical college, Allahabad from September 2015 to August 2016 a period of 12 months. The factors affecting the outcome were analyzed. Results: Out of the 34 children, there were 7 children less than 5 years and 27 were above 5 years of age. Poor outcome was seen in 42.8% children below 5 years, 35.7% in 6-10 years group, 15.3% in 11-15 years group. Male : female ratio was approximately 1:2. There were 4 patients in GCS of 3-8, of which 3 (75%) had a poor outcome; while out of 12 patients of GCS 9-12, 7 (58.3%) had poor outcome. Out of 18 patients in GCS 13-15, no patient had poor outcome. Twelve patients had abnormality of pupillary size and reaction, poor outcome was seen in 58.33% in contrast to only 13.6% with normal pupillary response. There were 12 patients with acute subdural hematoma, 5 patients had contusion, extradural hematoma in 11 patients, subarachnoid haemorrhage in 1 patient and multiple brain injuries in 5 patients. Poor outcome was noticed in 80% patients with multiple brain injuries,20% with contusion, 18.18% with acute subdural hematoma and 16.6% with extradural hematoma. Poor outcome noticed in 63.6% patients with midline shift > 5mm. Non operated patients had poor outcome (45.4%) than operated patients (21.7%). Poor outcome was noticed in 23.5% patients operated after 24 hour and 16.6% patients operated within 24 hour (Table 3). Overall poor outcome was seen in 10 (29.4%) of 34 children with head injury. Conclusion: The unfavorable prognostic factors for traumatic intracranial hematoma are RTA, low GCS (3-8), nonresponsive pupil to light, presence of multiple lesion on CT scan, midline shift > 5 mm, nonoperative lesions, the time elapsed from trauma to surgery > 24 hours.