du Plooy E, Salie S, Figaji A A
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Paediatric Intensive Care Unit, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
South Afr J Crit Care. 2024 Nov 25;40(3):e2212. doi: 10.7196/SAJCC.2024.v40i3.2212. eCollection 2024.
Paediatric traumatic brain injury (TBI) is a public health problem with high morbidity and mortality.
To highlight risk factors and describe associated morbidity and mortality of children admitted with TBI to the Paediatric Intensive Care Unit (PICU) at Red Cross War Memorial Children's Hospital, Cape Town.
We retrospectively documented the hospitalisation of all children with TBI admitted into our PICU between 2015 and 2019.
Of 320 children identified, 314 were enrolled: 267 (85%) had severe TBI (Glasgow Coma Scale (GCS) ≤8), 36 (11.5%) moderate TBI (GCS 9 - 12) and 11 (3.5%) mild TBI (GCS ≥13). Median age was 6.5 (interquartile range (IQR) 3.5 - 8.9) years; 194 (61.8%) were male. Motor vehicle collisions accounted for 75% (235) of injuries. Two hundred and seventy-nine (88.9%) children were invasively ventilated for a median of 4.5 (IQR 1 - 8) days; 13.9% (38/273) had a failed extubation and 10.8% (30/277) required tracheostomies. One hundred and sixty-three children (52.2%, n=312) had intracranial pressure monitoring. Almost a third (81/257) required vasopressor support. Approximately 40% (113/286) developed trauma-related seizures; 15.4% (44/286) required a thiopentone infusion and 6% (17/280) a decompressive craniectomy. Common complications were as follows: 12.2% developed post-extubation stridor (34/279), 10.5% a hemiparesis (33/314) and 6.4% diabetes insipidus (19/298). Median PICU stay was 4 (IQR 1 - 10) days, and hospitalisation 11 (IQR 5 - 21) days. Ninety-three (29.6%) children were transferred for further rehabilitation; 38 (12.1%) died.
Children admitted to our PICU with TBI had considerable morbidity and mortality, but this is a marked improvement since the 1990s. Enhanced primary preventive strategies, especially for motor vehicle collisions, are imperative to prevent TBI in children.
Paediatric traumatic brain injury (TBI) is associated with considerable morbidity and mortality. Through our profile of children with TBI admitted to PICU, we hope to contribute to future guidance and interventions to improve the quality of care in this subset of patients.
儿童创伤性脑损伤（TBI）是一个具有高发病率和死亡率的公共卫生问题。
强调开普敦红十字会战争纪念儿童医院儿科重症监护病房（PICU）收治的TBI患儿的危险因素，并描述其相关的发病率和死亡率。
我们回顾性记录了2015年至2019年间入住我院PICU的所有TBI患儿的住院情况。
在确定的320名儿童中，314名被纳入研究：267名（85%）为重度TBI（格拉斯哥昏迷量表（GCS）≤8），36名（11.5%）为中度TBI（GCS 9 - 12），11名（3.5%）为轻度TBI（GCS≥13）。中位年龄为6.5岁（四分位间距（IQR）3.5 - 8.9岁）；194名（61.8%）为男性。机动车碰撞导致75%（235例）的损伤。279名（88.9%）儿童接受有创通气，中位通气时间为4.5天（IQR 1 - 8天）；13.9%（38/273）拔管失败，10.8%（30/277）需要气管切开术。163名儿童（52.2%，n = 312）进行了颅内压监测。近三分之一（81/257）需要血管活性药物支持。约40%（113/286）发生创伤相关癫痫；15.4%（44/286）需要硫喷妥钠输注，6%（17/280）需要减压性颅骨切除术。常见并发症如下：12.2%发生拔管后喘鸣（34/279），10.5%发生偏瘫（33/314），6.4%发生尿崩症（19/298）。PICU中位住院时间为4天（IQR 1 - 10天），住院时间为11天（IQR 5 - 21天）。93名（29.6%）儿童被转至其他机构进行进一步康复治疗；38名（12.1%）死亡。
我院PICU收治的TBI患儿有相当高的发病率和死亡率，但与20世纪90年代相比已有显著改善。加强一级预防策略，尤其是针对机动车碰撞的预防策略，对于预防儿童TBI至关重要。
儿童创伤性脑损伤（TBI）与相当高的发病率和死亡率相关。通过我们对入住PICU的TBI患儿的描述，我们希望为未来的指导和干预措施做出贡献，以提高这部分患者的护理质量。
