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Vol. 46. Issue 6.
Pages 297-304 (June 2022)
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Vol. 46. Issue 6.
Pages 297-304 (June 2022)
Original article
Early prognostic factors for morbidity and mortality in severe traumatic brain injury. Experience in a child polytrauma unit
Factores pronósticos precoces de morbimortalidad en el traumatismo craneoencefálico grave en niños. Experiencia en una unidad de politraumatismo infantil
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M. Cabrero Hernándeza,
Corresponding author
, M.I. Iglesias Bouzasa, A. Martínez de Azagra Gardea, E. Pérez Suárezb, A. Serrano Gonzáleza, R. Jiménez Garcíac
a Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
b Servicio de Urgencias Pediátricas, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
c Sección de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Abstract
Objective

To identify early prognostic factors that lead to an increased risk of unfavorable prognosis.

Design

Observational cohort study from October 2002 to October 2017.

Setting and patients

Patients with severe TBI admitted to intensive care were included.

Variables and interventions

Epidemiological, clinical, analytical and therapeutic variables were collected. The functional capacity of the patient was assessed at 6 months using the Glasgow Outcome Scale (GOS). An unfavorable prognosis was considered a GOS less than or equal to 3. A univariate analysis was performed to compare the groups with good and bad prognosis and their relationship with the different variables. A multivariate analysis was performed to predict the patient's prognosis.

Results

98 patients were included, 61.2% males, median age 6.4 years (IQR 2.49–11.23). 84.7% were treated by the out-of-hospital emergency services. At 6 months, 51% presented satisfactory recovery, 26.5% moderate sequelae, 6.1% severe sequelae, and 2% vegetative state. 14.3% died. Statistical significance was found between the score on the prehospital Glasgow coma scale, pupillary reactivity, arterial hypotension, hypoxia, certain analytical and radiological alterations, such as compression of the basal cisterns, with an unfavorable prognosis. The multivariate analysis showed that it is possible to make predictive models of the evolution of the patients.

Conclusions

it is possible to identify prognostic factors of poor evolution in the first 24 h after trauma. Knowledge of them can help clinical decision-making as well as offer better information to families.

Palabras clave:
Trauma craneal
Pediatría
Politraumatismo
Resumen
Objetivo

Identificar factores pronósticos precoces que conduzcan a un mayor riesgo de pronóstico desfavorable.

Diseño

Estudio de cohortes observacional de octubre 2002 a octubre 2017.

Pacientes y ámbito

Se incluyeron pacientes menores de 18 años con TCE grave ingresados en cuidados intensivos (UCIP).

Variables e intervenciones

Se recogieron variables epidemiológicas, clínico-analíticas y terapéuticas. Se valoró la capacidad funcional del paciente a los 6 meses mediante la Glasgow Outcome Scale (GOS). Se consideró pronóstico desfavorable un GOS menor o igual a 3. Se realizó un análisis univariante para comparar grupos de buen y mal pronóstico y su relación con las diferentes variables. Se realizó un análisis multivariante para predecir el pronóstico del paciente.

Resultados

98 pacientes, 61,2% varones, mediana de edad 6,4 años (RIQ 2.49–11.23). El 84,7% fueron atendidos por los servicios de emergencias extrahospitalarios. A los 6 meses, el 51% presentaba recuperación satisfactoria, 26,5% secuelas moderadas, 6,1% secuelas graves y 2% estado vegetativo. Fallecieron el 14,3%. Hubo significación estadística entre la puntuación en la escala de coma de Glasgow (ECG) prehospitalaria, reactividad pupilar, hipotensión arterial, hipoxia, ciertas alteraciones analíticas y radiológicas (compresión de las cisternas basales), con pronóstico desfavorable. El análisis multivariante demostró que es posible realizar modelos predictores de la evolución de los pacientes.

Conclusiones

Es posible identificar factores pronósticos de mala evolución en las primeras 24 horas postraumatismo. Su conocimiento puede ayudar a la toma de decisiones clínicas y ofrecer una mejor información a las familias.

Keywords:
Trauma craneal
Pediatría
Politraumatismo

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