Scavarda Didier, Gabaudan Charline, Ughetto Fabrice, Lamy Frederic, Imada Vanessa, Lena Gabriel, Paut Olivier
Department of Pediatric Neurosurgery, CHU Timone Enfants, 264 rue Saint Pierre, 13385, Marseille cedex 05, France.
Childs Nerv Syst. 2010 Nov;26(11):1555-61. doi: 10.1007/s00381-010-1150-x. Epub 2010 May 12.
The aim of this study is to evaluate the outcome of young children hospitalized for non-accidental head trauma in our PICU, to evaluate PRISM II score in this sub-population of pediatric trauma and to identify factors that might influence the short-term outcome.
Files of all children less than 2 years old with the diagnosis of non-accidental head trauma over a 10-years period were systematically reviewed. We collected data on demographic information, medical history, clinical status, and management in the PICU. Three severity scores were then calculated: PRISM II, Glasgow Coma Scale (GCS), and Pediatric Trauma Score (PTS). Prognosis value of qualitative variables was tested with a univariate procedure analysis (anemia, diabetes insipidus...). Then, quantitative variables were tested with univariate procedure too (age, weight, PRISM II, GCS, Platelet count, fibrin, prothrombin time (PT)...). Potential association between variables and death was tested using univariate procedure. Variables identified by univariate analysis were then analyzed with multivariate analysis through a forward-stepping logistic regression.
Thirty-six children were included. Mean age was 5.5 months (8 days-21.5 months). Mortality rate was 27.8%. At admission, PTS, PRISM II, GCS, PT, PTT, and diabetes insipidus were significantly altered or more frequent in non survivors. Cutoff value for PRISM II at which risk of mortality increased was 17.5 (sensitivity = 0.8; specificity = 0.88).
PRISM II is a reliable and easy performing tool for assessing the prognosis of non-accidental cranial traumatism in young children. GCS and PTS, scores even simpler than PRISM II, showed good accuracy regarding survival prediction.
本研究旨在评估入住我院儿科重症监护病房（PICU）的非意外性头部创伤幼儿的治疗结果，评估该儿科创伤亚组中的PRISM II评分，并确定可能影响短期预后的因素。
系统回顾了10年间所有诊断为非意外性头部创伤的2岁以下儿童的病历。我们收集了人口统计学信息、病史、临床状况以及在PICU的治疗情况等数据。然后计算了三个严重程度评分：PRISM II、格拉斯哥昏迷量表（GCS）和儿科创伤评分（PTS）。通过单变量程序分析（贫血、尿崩症……）测试定性变量的预后价值。然后，也通过单变量程序测试定量变量（年龄、体重、PRISM II、GCS、血小板计数、纤维蛋白、凝血酶原时间（PT）……）。使用单变量程序测试变量与死亡之间的潜在关联。通过向前逐步逻辑回归对单变量分析确定的变量进行多变量分析。
纳入36名儿童。平均年龄为5.5个月（8天至21.5个月）。死亡率为27.8%。入院时，非幸存者的PTS、PRISM II、GCS、PT、PTT和尿崩症明显改变或更常见。死亡率增加时PRISM II的临界值为17.5（敏感性 = 0.8；特异性 = 0.88）。
PRISM II是评估幼儿非意外性颅脑创伤预后的可靠且易于操作的工具。GCS和PTS评分甚至比PRISM II更简单，在生存预测方面显示出良好的准确性。
