Management of Severe Head Injury in Children
Head injury is a major primary cause of morbidity and mortality among children and adolescents, often resulting in permanent disability for those who survive. In the United States, children and young adults make up more than half of all new head injury cases with an annual incidence rate of 185 per 100000 population for children up to 15 years old . Pediatric head injury may differ from adult head trauma in many respects. Etiology includes child abuse and a predominance of falls in young ages, whereas road accidents are the main cause in children around 7–12 years of age. Early convulsive episodes are frequent events and may render reliable neurologic examination and assessment of severity of injury by means of Glasgow Coma Scale (GCS) difficult. Up to the age of 10–12 years, the neck is relatively weak compared to the weight of the head. In high energy accidents associated with lethal outcome, lesions are frequently found at the craniocervical junction including laceration hemorrhage or infarction of the cord at the level of C1–3 . Furthermore, the morphological reaction in children to severe head injury differs from adults. The incidence of space occupying intracranial hematoma is less frequent (20–22%), but the presence of diffuse cerebral swelling due to cerebral hyperemia is noted in 50–70% of severe cases [3, 4]. A substantial part of head injuries in childhood can be classified as minor injury  with however, an occasionally intriguing and undulating course of posttraumatic stupor. Admission of these patients to an intensive care unit is rarely indicated, and management in the acute phase is straightforward (mainly clinical observation). In contrast, intensive care management of children with severe head injuries is complex and includes general aspects (airway control, mechanical ventilation, cardiovascular support, control of internal milieu, and treatment of associated lesions), and specific measures focusing on the central nervous system (CNS). The diversity of problems can only be solved by a team of specialists (anesthesiologist, neurosurgeon, general/pediatric surgeon, pediatric intensivist, etc.) who follow commonly developed guidelines in their trauma center. The following is an outline of present day management of the severely head injured child with emphasis on the pathophysiological rationale for therapy.
KeywordsMean Arterial Pressure Head Injury Glasgow Coma Scale Cerebral Perfusion Pressure Glasgow Outcome Scale
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