Severe head injury in children--a preventable but forgotten epidemic.

OBJECTIVE

To determine the outcome of seriously head-injured children and to analyse the factors that affect their prognosis.

DESIGN

A retrospective analysis of all severely head-injured children treated between 1990 and 1993.

SETTING

Red Cross War Memorial Children's Hospital's trauma unit and neurosurgery service.

PATIENTS

One hundred and two children under the age of 14 years with admission Glasgow Coma Scores (GCSs) of below 8.

RESULTS

There were 57 boys and 45 girls. The average time of assessment after injury was 2.8 hours. Eighty-three injuries were caused by pedestrian motor vehicle accidents. Thirty-seven were associated with other serious organ system injuries. Fifty-eight children died and only 36 made a good recovery. All children with a GCS of 3-4 died. Factors that were particularly associated with a poor prognosis were: (i) age less than 3 years; (ii) associated extracranial injury; (iii) GCS 3-4 following resuscitation; and (iv) diffuse cerebral swelling on computed tomography.

CONCLUSION

Pedestrian motor vehicle accidents are the most common cause of serious paediatric head injury in the Cape Town area. Children with a presenting coma score of less than 8 have an extremely high mortality and morbidity rate, despite modern intensive care. Preventive strategies are essential.