Riemann Lennart, Zweckberger Klaus, Unterberg Andreas, El Damaty Ahmed, Younsi Alexander
Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
Front Neurol. 2020 Apr 30;11:345. doi: 10.3389/fneur.2020.00345. eCollection 2020.
Traumatic brain injury (TBI) is the leading cause of death and disability in children. It includes a range of different pathologies that differ considerably from adult TBI. Analyzing and understanding injury patterns of pediatric TBI is essential to establishing new preventive efforts as well as to improve clinical management. The multi-center, prospectively collected CENTER-TBI core and registry databases were screened and patients were included when younger than 18 years at enrollment and admitted to the regular ward (admission stratum) or intensive care unit (ICU stratum) following TBI. Patient demographics, injury causes, clinical findings, brain CT imaging details, and outcome (GOSE at 6 months follow-up) were retrieved and analyzed. Injury characteristics were compared between patients admitted to the regular ward and ICU and multivariate analysis of factors predicting an unfavorable outcome (GOSE 1-4) was performed. Results from the core study were compared to the registry dataset which includes larger patient numbers but no follow-up data. Two hundred and twenty seven patients in the core dataset and 687 patients in the registry dataset were included in this study. In the core dataset, road-traffic incidents were the most common cause of injury overall and in the ICU stratum, while incidental falls were most common in the admission stratum. Brain injury was considered serious to severe in the majority of patients and concurrent injuries in other body parts were very common. Intracranial abnormalities were detected in 60% of initial brain CTs. Intra- and extracranial surgical interventions were performed in one-fifth of patients. The overall mortality rate was 3% and the rate of unfavorable outcome 10%, with those numbers being considerably higher among ICU patients. GCS and the occurrence of secondary insults could be identified as independent predictors for an unfavorable outcome. Injury characteristics from the core study could be confirmed in the registry dataset. Our study displays the most common injury causes and characteristics of pediatric TBI patients that are treated in the regular ward or ICU in Europe. Road-traffic incidents were especially common in ICU patients, indicating that preventive efforts could be effective in decreasing the incidence of severe TBI in children.
创伤性脑损伤（TBI）是儿童死亡和残疾的主要原因。它包括一系列与成人TBI有很大差异的不同病理情况。分析和了解小儿TBI的损伤模式对于制定新的预防措施以及改善临床管理至关重要。对多中心前瞻性收集的CENTER-TBI核心数据库和注册数据库进行了筛选，纳入了入组时年龄小于18岁且在TBI后入住普通病房（入院层）或重症监护病房（ICU层）的患者。收集并分析了患者的人口统计学资料、损伤原因、临床发现、脑部CT成像细节以及结局（6个月随访时的GOSE评分）。比较了入住普通病房和ICU的患者的损伤特征，并对预测不良结局（GOSE 1-4）的因素进行了多变量分析。将核心研究的结果与注册数据集进行了比较，注册数据集包括更多患者，但没有随访数据。本研究纳入了核心数据集中的227例患者和注册数据集中的687例患者。在核心数据集中，道路交通事件是总体上以及ICU层中最常见的损伤原因，而意外跌倒在入院层中最常见。大多数患者的脑损伤被认为是严重到极重度，其他身体部位的并发损伤非常常见。60%的初次脑部CT检查发现颅内异常。五分之一 的患者接受了颅内和颅外手术干预。总体死亡率为3%，不良结局率为10%，ICU患者中的这些数字要高得多。格拉斯哥昏迷量表（GCS）评分和继发性损伤的发生可被确定为不良结局的独立预测因素。核心研究的损伤特征在注册数据集中得到了证实。我们的研究展示了在欧洲普通病房或ICU接受治疗的小儿TBI患者最常见的损伤原因和特征。道路交通事件在ICU患者中尤为常见，这表明预防措施可能有效地降低儿童严重TBI的发生率。
