Effect of Neurointensive Care upon Outcome Following Severe Head Injuries in Childhood - A Preliminary Report

Abstract

From March 1978 till August 1981 neurointensive care was applied to 24 children with severe head injuries (Glasgow Coma Scale ≤ 7, mean 5 ± 1) corresponding to 7 % of a population with head injuries observed during the same period.

The neurointensive care included continuous intracranial and arterial pressure monitoring and normalization of intracranial and cerebral perfusion pressure with intubation, hyperventilation, control of body temperature, dexamethason, barbiturates and osmotic agents.

The follow-up time is 1.5 to 4.4 years (mean 2.5 years). The results obtained by check-ups every 3-6 months were analyzed as proposed by Lange-Cosack and Tepfer (1973) and used to group the children according to Jennett and Bond (1975).

At the end of the follow-up four children were 1-5, twelve 6-14 years old and 3 older. Five patients (= 21 %) died during the acute stage of head injury. Residual neurological signs were present in 42 % of the children depending on the specific topics (cranial nerve deficits, hemiparesis, speech disorders, ataxic syndromes) at most in Πof the cases. Minimal to distinct residual psychoorganic signs were found in 58 %, an altered personality being somewhat more frequent than intelligence deficit or psychomotor retardation. Eleven of the twelve school children are back in school of whom are eight in regular and three in special schools. At a mean time of 1.5 years after the accident the EEG was normal in nine cases and displayed a slightly altered background activity and/or slow wave foci in eight and epileptiform foci in two cases. Convulsions were observed in two children. CT on follow-up was abnormal in 31 %. 6-12 months after trauma thirteen of the nineteen surviving patients belonged to group 5 of the Glasgow Outcome Scale, three to group 4 and three to group 3. None displayed a permanent vegetative state. Today sixteen belong to group 5.

The results confirm a faster recovery and a better longrange outcome of a severely head injured child with neurointensive care than without it.

Key words

Head injuries - Neurointensive care - Outcome following severe head injuries