Division of Pediatric Critical Care, Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA.
Pediatr Crit Care Med. 2018 Jul;19(7):649-657. doi: 10.1097/PCC.0000000000001554.
To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings.
Prospective study.
Four hospitals in Sub-Saharan Africa.
Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy.
None.
We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy. Pediatric Cerebral Performance Category score was assessed pre morbidity and at hospital discharge. Overall, 130 children were studied (58 [45%] had traumatic brain injury) from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7). Forty-six percent had no prehospital care, and 64% required interhospital transport over 18 km (1-521 km). On comparing traumatic brain injury with infectious encephalopathy, there was no difference in presentation with altered mental state (80% vs 82%), but a greater proportion of traumatic brain injury cases had loss of consciousness (80% vs 53%; p = 0.004). Traumatic brain injury patients were older (median [range], 120 mo [6-204 mo] vs 13 mo [0.3-204 mo]), p value of less than 0.001, and more likely male (73% vs 51%), p value of less than 0.01. In 78% of infectious encephalopathy cases, cause was unknown. More infectious encephalopathy cases had a seizure (69% vs 12%; p < 0.001). In regard to outcome, infectious encephalopathy versus traumatic brain injury: hospital lengths of stay were longer for infectious encephalopathy (8 d [2-30 d] vs 4 d [1-36 d]; p = 0.003), discharge rate to home, or for inpatient rehabilitation, or death differed between infectious encephalopathy (85%, 1%, and 13%) and traumatic brain injury (79%, 12%, and 1%), respectively, p value equals to 0.044. There was no difference in the proportion of children surviving with normal or mild disability (73% traumatic brain injury vs 79% infectious encephalopathy; p = 0.526).
The epidemiology and outcomes of pediatric traumatic brain injury and infectious encephalopathy varied by center and disease. To improve outcomes of these conditions in low-resource setting, focus should be on neurocritical care protocols for pre-hospital, hospital, and rehabilitative care.
评估在资源匮乏环境下儿童创伤性脑损伤或感染性脑病的发病频率、干预措施和结局。
前瞻性研究。
撒哈拉以南非洲的 4 家医院。
在医院接受评估的患有创伤性脑损伤或感染性脑病的 1 天至 17 岁的儿童。
无。
我们评估了连续 4 周内在任何医院科室就诊的患有创伤性脑损伤或感染性脑病的儿童的频率和结局。在发病前和出院时，采用儿科脑功能分类评分对患儿进行评估。共有 130 名儿童（58 名[45%]患有创伤性脑损伤）参与了这项来自埃塞俄比亚（n=51）、肯尼亚（n=50）、卢旺达（n=20）和加纳（n=7）医院的研究。46%的患儿没有院前治疗，64%的患儿需要在 18 公里以上的医院间转运（1-521 公里）。在比较创伤性脑损伤和感染性脑病时，虽然两组患儿均有精神状态改变（80%比 82%），但创伤性脑损伤患儿更易发生意识丧失（80%比 53%；p=0.004）。创伤性脑损伤患儿年龄较大（中位数[范围]：120 个月[6-204 个月]比 13 个月[0.3-204 个月]，p 值小于 0.001），且更可能为男性（73%比 51%，p 值小于 0.01）。78%的感染性脑病病例病因不明。更多的感染性脑病患儿有癫痫发作（69%比 12%；p<0.001）。在结局方面，感染性脑病与创伤性脑损伤相比：感染性脑病患儿的住院时间更长（8 天[2-30 天]比 4 天[1-36 天]；p=0.003），出院回家、接受住院康复或死亡的比例在感染性脑病患儿（85%、1%和 13%）和创伤性脑损伤患儿（79%、12%和 1%）之间存在差异（p=0.044）。存活患儿中无明显残疾或轻度残疾的比例无差异（创伤性脑损伤患儿为 73%，感染性脑病患儿为 79%；p=0.526）。
儿科创伤性脑损伤和感染性脑病的流行病学和结局因中心和疾病而异。为改善这些疾病在资源匮乏环境下的结局，应关注创伤性脑损伤和感染性脑病患儿的院前、院内和康复期神经重症护理方案。
