Effect of multiple trauma on outcome of pediatric patients with neurologic injuries.

In a 3-year period, 95 patients with severe head injury (unconsciousness greater than 6h duration) were treated at our institution. Of these, 46 patients (48%) had isolated head injury and 49 (52%) had head injury plus severe multiple trauma. Multiple trauma was scored using the Modified Injury Severity Scale. All patients in the multiple trauma group had at least one additional area of severe injury. Severity of head injury, judged by Glasgow Coma Score, presence of mass lesions, abnormal posturing or flaccidity, impaired or absent oculocephalic reflexes, and fixed, dilated pupils, was much greater in the isolated head injury group. In spite of this, poor outcome (death or vegetative/severe disability) was 2 1/2 times as frequent in the multiple trauma group. Shock, refractory hypoxemia and sepsis were contributing factors in this increased morbidity and mortality. Increasing Modified Injury Severity Scale scores were associated with increased morbidity and mortality.