Survey of pediatric head injury - GMCH experience

Joshi, Gauri
July 2007
Journal of Pediatric Neurosciences;Jul-Dec2007, Vol. 2 Issue 2, p99
Academic Journal
AIMS AND OBJECTIVES: 1) to study the pattern of pediatric head injury. 2) to study the radiological features, their correlation with clinical features and their outcome. 3) to understand the prognostic factors for overall outcome of the patients. MATERIALS AND METHODS: About seven hundred patients below the age of twelve years, who had head injury, were seen in our hospital from Jan 2005 to July 2007. These included patients of all grades of head injury. All patients were graded by the Glasgow Coma Score (GCS). CT scan of brain was done. Outcome of the patients was assessed by the Glasgow Outcome Score. RESULTS: Out of these, about ninety patients required admission. Rest all patients had minor head injury and were managed from surgery emergency only. Road side accident and fall from a height were the most common causes. More than fifteen percent of patients were comatose for six hours or longer. Twenty patients were operated. Out of these, surgery for extradural hematoma was the most common, followed by SDH in three patients and depressed fracture in two patients. Fifteen patients died, all in the first 2-3 days. Only one patient operated for SDH died. There was no particular relation between the 1_" rn of injury, CT findings and mortality: Six patients were ventilated in the There were 15 patients who had a prolonged unconsciousness of more than week. Majority of these patients had intraventricular hemorrhage, tentorial subarachnoid hemorrhage, and small deep located contusions suggestive of diffuse axonal injury. Five patients required treatment for post traumatic meningitis. Only one patient stayed in persistent vegetative state even after one year. All these fifteen patients had recovery but with deficit like limb weakness, IQ derangement, poor scholastic performances or speech disturbances. CONCLUSION: 1) Majority of the head injury patients had good recovery. 2) CT scan findings like intraventricular hemorrhage, subarachnoid hemorrhage, and diffuse axonal injury suggested a prolonged course. Factors like high impact of injury, poor GCS at admission also indicated poor prognosis. 3) Sometimes patients with a trivial injury and no gross findings on CT scan, had a poor outcome thereby pointing towards a high suspicion index and alertness in management of "pediatric patients.


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