Wani Abrar Ahad, Sarmast Arif Hussain, Ahangar Muzaffar, Malik Nayil Khursheed, Chhibber Sarabjit Singh, Arif Sajad Hussain, Ramzan Altaf Umar, Dar Bashir Ahmed, Ali Zulfiqar
Department of Neurosurgery, Sher-I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Department of Neurosurgery, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India.
J Pediatr Neurosci. 2017 Oct-Dec;12(4):332-337. doi: 10.4103/jpn.JPN_80_17.
Traumatic brain injury (TBI) in children is a significant cause of morbidity and mortality worldwide. Falls are the most common type of injury, followed by motor vehicle-related accidents and child abuse.
The aim and objective of this study was to elucidate the various modes of injury, prognostic factors, complications, incidence of various modes of injury, and outcome in TBI in pediatric population.
Patients with TBI, 18 years or less in age, managed in our Department of Neurosurgery, over a period of 2 years, were studied prospectively. Detailed history, general physical examination, systemic examination, and central nervous system examination including assessment of Glasgow Coma Scale score (GCS) and pupillary size and reaction were noted in every patient. Based on GCS, patients were divided into mild head injury (GCS 13-15), moderate head injury (GCS 9-12), and severe head injury (GCS ≤8) categories. All the patients were subjected to plain computed tomography (CT) scan head, and CT findings were noted. Patients were managed conservatively or surgically as per the standard indications. The outcome of all these patients was assessed by Glasgow outcome scale and divided into good (normal, moderate disability) and poor (severe, vegetative, dead) outcome. Outcome was assessed in relation to age, sex, GCS, pupil size and reaction, CT scan features, intervention, and associated injuries.
A total of 403 patients aged between 1 day and 18 years were included in the study comprising 252 males (63%) and 151 females (37.75%). The common modes of injury were fall 228 (56.6%) followed by road traffic accidents 138 (34.2%), assault 10 (2.5%), and others 27 (6.7%) which include sports injury, hit by some object on head, and firearm injury. Majority of our patients had a GCS of 13-15 (mild head injury), 229 (57.3%), followed by 9-12 (moderate head injury) 119 (29.8%), followed by 8 or less (severe head injury) 52 (13%). In group of patients in the category of GCS ≤ 8, poor outcome was seen in 65.3%, followed by patients in group GCS 9-12 at 2.45% succeeded by group of patients with GCS 13-15 at 2.6%, which was statistically significant ( < 0.0001). A total of 354 (87.8%) patients had normal pupils, 37 (9.2%) had anisocoria, and 12 (3%) patients had fixed dilated pupils. Fixed dilated pupil had poor outcome (100%) followed by anisocoria (40.5%) and normal pupils (16%), which was statistically significant ( < 0.0001).
Majority of children who suffer from TBI do well although it still continues to be a significant cause of morbidity and mortality in them. The outcome is directly related to the neurological status in which they present to the hospital.
儿童创伤性脑损伤（TBI）是全球发病和死亡的重要原因。跌倒 是最常见的损伤类型，其次是机动车相关事故和虐待儿童。
本研究的目的是阐明儿科人群 TBI 的各种损伤方式、预后因素、并发症、各种损伤方式的发生率及结局。
前瞻性研究了在我院神经外科治疗的 2 年内年龄在 18 岁及以下的 TBI 患者。记录每位患者的详细病史、全身体格检查、系统检查以及包括格拉斯哥昏迷量表（GCS）评分、瞳孔大小和反应评估在内的中枢神经系统检查结果。根据 GCS，将患者分为轻度颅脑损伤（GCS 13 - 15）、中度颅脑损伤（GCS 9 - 12）和重度颅脑损伤（GCS≤8）类别。所有患者均接受头部平扫计算机断层扫描（CT），并记录 CT 检查结果。根据标准指征对患者进行保守或手术治疗。所有这些患者的结局通过格拉斯哥结局量表进行评估，并分为良好（正常、中度残疾）和不良（重度、植物人状态、死亡）结局。根据年龄、性别、GCS、瞳孔大小和反应、CT 扫描特征、干预措施及相关损伤评估结局。
本研究共纳入 403 例年龄在 1 天至 18 岁之间的患者，其中男性 252 例（63%），女性 151 例（37.75%）。常见的损伤方式依次为跌倒 228 例（56.6%）、道路交通事故 138 例（34.2%）、袭击 10 例（2.5%）和其他 27 例（6.7%），其他包括运动损伤、头部被物体击中及火器伤。大多数患者 GCS 为 13 - 15（轻度颅脑损伤），共 229 例（57.3%），其次是 9 - 12（中度颅脑损伤）119 例（29.8%），8 分及以下（重度颅脑损伤）52 例（13%）。在 GCS≤8 的患者组中，不良结局发生率为 65.3%，其次是 GCS 9 - 12 组，为 2.45%，GCS 13 - 15 组为 2.6%，差异有统计学意义（<0.0001）。共有 354 例（87.8%）患者瞳孔正常，37 例（9.2%）有瞳孔不等大，12 例（3%）患者瞳孔固定散大。瞳孔固定散大的患者不良结局发生率为 100%，其次是瞳孔不等大（40.5%）和瞳孔正常（16%），差异有统计学意义（<0.0001）。
大多数 TBI 患儿预后良好，尽管 TBI 仍是其发病和死亡的重要原因。结局与患儿入院时的神经状态直接相关。
