TRAUMATIC HEAD INJURY IN CHILDREN IN SOUTH TUNISIA EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND EVOLUTION. A propos 454 cases

##plugins.themes.academic_pro.article.sidebar##

Download
pdf
Vol. 87 No. 1 (2009): Issue Jan 2009

##plugins.themes.academic_pro.article.main##

Mabrouk Bahloul
Service de Réanimation polyvalente
Hedi Chelly
Service de Réanimation polyvalente
Riadh Gargouri
Service de Réanimation polyvalente
Hassan Dammak
Service de Réanimation polyvalente
Hatem Kallel
Service de Réanimation polyvalente
Chokri Ben Hamida
Service de Réanimation polyvalente
Noureddine Rekik
Service de Réanimation polyvalente
Khaireddine Ben Mahfoudh
Service de Radiologie
Riadh Rebaii
Service de Neurochirurgie CHU H. Bourguiba Sfax Tunisie
Mongia Hachicha
Service de pédiatrie Générale CHU H Chaker Sfax Tunisie
Mounir Bouaziz
Service de Réanimation polyvalente

Abstract

Aim : To determine epidemiological, causes, clinical and Para clinical manifestations and outcome in children with traumatic head injury in south Tunisia.
Methods: A retrospective study over a 8 year period (1997 - 2004) of 454 children’s with head injury admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during the ICU stay.
Results: Mean age (± SD) was of 7, 2 ± 3, 8 years. The main cause of trauma was traffic accidents (69, 4%). There were a predominance of male patient’s with a sex-ratio of 2, 21. The Score of coma of Glasgow adapted to the child, was on average from 8 ± 3 points. Extra-cranial pathology was present were observed in 38,9 %. The cerebral CT-Scan performed on admission for all patients was pathological in 86,3 % of the cases. The most observed lesions were meningeal Haemorrhage (35,2 %) and the cerebral contusion (34,5 %). According to the « Traumatic Coma Dated Bank classification " we noted a high proportion of type 2
group(46 %). Secondary systemic insults were observed in 377 children (83 %). Evolution was marked by the death of 82 children (18 %). Among survivors, a good recovery was observed in 229 children (50, 4 %).
Conclusion: In Tunisia, head injury is a frequent cause of hospitalization. It is essentially involved in traffic accidents. The short term prognosis is poor with a high (18%) mortality. Prevention is highly advised.

Keywords:

Trauma, Children, Intensive Care Unit, Prognosis, Motor-vehicle crash, Acute head injury

##plugins.themes.academic_pro.article.details##

References

  1. Bahloul M, Chelly H, Ben Hmida M, Ben Hamida C, Ksibi H, Kallel H, Chaari A, Kassis M, Rekik N, Bouaziz M. Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases. J Trauma. 2004; 57: 255-61.
  2. Shackford SR, Mackersie RC, Holbrook TL, Davis JW, Hollingsworth-Fridlund P, Hoyt DB, Wolf PL. The epidemiology of traumatic death. A population-based analysis.Arch Surg 1993; 128:571-575
  3. Granry JC, Dube L, Terminassian A, Frebet E, Le Rolle T. Multimodal monitoring of head injuries in children. Ann Fr Anesth Reanim. 2002; 21:148-56.
  4. Simpson D, Reilly P. Pediatric coma scale. Lancet 1982; 2: 450.
  5. P. E. Bollaert, D. Annane, H. Aube, J. P. Bedos, A. Cariou, D. du Cheyron, M. Gainnier, B. Guillois, G. Hilbert, T. Lecompte et al. Coagulations intravasculaires disséminées (CIVD) en réanimation : définition, classification et traitement (à l'e
  6. Marshall LF, Marshall SB, Klauber MR, van Berkum Clark M. Anew classification of head injury based on computerized tomography. Journal of Neurosurgery 1991;75(suppl):S14-S20.
  7. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J. Trauma. 1974; 14: 187-196.
  8. Tepas JJ 3rd, DiScala C, Ramenofsky ML, Barlow B.. Mortality and head injury: the pediatric perspective.. J Pediatr Surg. 1990; 25: 92-5.
  9. Pollack MM, Ruttimann UE, Getson PR.. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16: 1110-6.
  10. Groeneveld AB, Tran DD, van der Meulen J, Nauta JJ, Thijs LG.. Acute renal failure in medical intensive care unit: predisposing, complicating factors and outcome. Nephron 1991; 59: 602-610.
  11. Sampson JH, Rossitch E Jr, Oakes WJ. Initial management of pediatric head trauma. Am Fam Physician. 1992; 45: 2621-8.
  12. Meyer P, Charron B, Jarreau MM, Orliaguet G, Blanot S. Particularités du traumatisme crânien chez l'enfant : épidémiologie et physiopathologie. In Actualités en réanimation et urgences, SRLF rd, Paris Elsevier, 2000 : 469- 87.
  13. Biswas AK, Bruce DA, Sklar FH, Bokovoy JL, Sommerauer JF. Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension. Crit Care Med. 2002; 30:2742-51.
  14. Odebode TO, Abubakar AM. Childhood head injury: causes, outcome, and outcome predictors. A Nigerian perspective. Pediatr Surg Int. 2004; 20: 348-52.
  15. Michaud LJ, Rivara FP, Grady MS, Reay DT. Predictors of survival and severity of disability after severe brain injury in children. Neurosurgey 1992; 31:254-264.
  16. Tsai WC, Chiu WT, Chiou HY, Choy CS, Hung CC, Tsai SH. Pediatric traumatic brain injuries in Taiwan: an 8-year study. J Clin Neurosci. 2004 ;11 :126-9.
  17. Zargar M, Sayyar Roudsari B, Shadman M, Kaviani A, Tarighi P. Pediatric transport related injuries in Tehran: the necessity of implementation of injury prevention protocols. Injury. 2003; 34: 820-4
  18. Kraus JF, Rock A, Hemyari P.. Brain injuries among infants, children, adolescents, and young adults. Am J Dis Child. 1990; 144: 684-91.
  19. White JR, Farukhi Z, Bull C, Christensen J, Gordon T, Paidas C, Nichols DG.Predictors of outcome in severely head injured children.Critical care Med 2001; 29: 534-540.
  20. Emanuelson I, v Wendt L..Epidemiology of traumatic brain injury in children and adolescents in south-western Sweden. Acta Paedriatr 1997; 86: 730-5.
  21. Durkin MS, Laraque D, Lubman I, Barlow B.Epidemiology and prevention of traffic injuries to urban children and adolescents. Pedaitrics 1999; 103: 74.
  22. Javouhey E , Chiron M. Epidémiologie des traumatismes par accident de circulation chez l'enfant. Conf Med SFMU LC. Urgences 2003; 7: 39 pp 3-16.
  23. Istre GR, McCoy MA, Stowe M, Davies K, Zane D, Anderson RJ, Wiebe R.Childhood injuries due to falls from apartment balconies and windows. Inj Prev. 2003; 9: 349-52..
  24. Cooke RS, McNicholl BP, Byrnes DP. Early management of severe head injury in Northern Ireland Injury. 1995; 26(6):395-7.
  25. Silverston P.. Pulse oximetry at the roadside: a study of pulse oximetry in immediate care. BMJ. 1989; 298: 711-3.
  26. Ramundo GB, Larach DR.. A monitor with a mind of its own. Anesthesiology. 1995; 82: 317.
  27. Latronico N..Pupils and coma.India. 2003; 51(1):16-8.
  28. Levi L, Guilburd JN, Bar-Yosef G, Zaaroor M, Soustiel JF, Feinsod M. Severe head injury in children--analyzing the better outcome over a decade and the role of major improvements in intensive care.. Childs Nerv Syst. 1998; 14: 195-202..
  29. Meyer P. Principe de réanimation en neurotraumatologie pédiatrique. JEUR 1994 ; 4 : 193-8. 9.
  30. Born JD. The Glasgow-Liege Scale. Prognostic value and evolution of motor response and brain stem reflexes after severe head injury.Acta Neurochir (Wien). 1988; 91: 1-11.
  31. Levati A, Farina ML, Vecchi G, Rossanda M, Marrubini MB. Prognostic of severe head injury. J Neurosurg. 1982; 57: 779-83..
  32. Katsura K, Folbergrova J, Gido G, Siesjo BK..Functional, metabolic, and circulatory changes associated with seizure activity in thepostischemic brain. J Neurochem. 1994; 62: 1511-5..
  33. Dias MS.. Traumatic brain and spinal cord injury. Pediatr Clin North Am. 2004 : 51: 271-303.
  34. Temkin NR, Dikmen SS, Winn HR.Management of head injury. Posttraumatic seizures. Neurosurg Clin N Am. 1991; 2: 425-35.
  35. Ates O, Ondul S, Onal C, Buyukkiraz M, Somay H, Cayli SR, et al.. Post-traumatic early epilepsy in pediatric age group with emphasis on influential factors.Childs Nerv Syst. 2006 ; 22:279-284
  36. Frey LC.. Epidemiology of Posttraumatic, Epilepsy: A Critical Review. Epilepsia. 2003; 44 (Suppl)10:11-7.
  37. Pierrot M, Francois V, Minassian AT, Clavier N, Boulard G, Beydon L. The impact of a French guideline on the clinical management of severe head injury (SHI) published in 1999. Ann Fr Anesth Reanim. 2003; 22:12-7.
  38. Ramundo ML, McKnight T, Kempf J, Satkowiak L.. Clinical predictors of computed tomographic abnormalities following pediatric traumatic brain injury. Pediatr Emerg Care. 1995; 11:1-4.
  39. Servadei F, Nanni A, Nasi MT, Zappi D, Vergoni G, Giuliani G, Arista A.. Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgey 1995; 37: 899-906.
  40. Hirsch W, Schobess A, Eichler G, Zumkeller W, Teichler H, Schluter A..Severe head trauma in children: cranial computer tomography and clinical consequences. Paediatr Anaesth. 2002; 12: 337-44.
  41. Moront ML, Williams JA, Eichelberger MR, Wilkinson JD. The injured child. An approach to care. Pediatr Clin North Am. 1994; 41: 1201-26..
  42. Pfenninger J. Neurological intensive care in children. Intensive Care Med. 1993;19 :243-50
  43. dos Santos AL, Plese JP, Ciquini Junior O, Shu EB, Manreza LA, Marino Junior R.. Extradural hematomas in children. Pediatr Neurosurg. 1994; 21: 50-4.
  44. Gentry LR.. Imaging of closed head injury.Radiology. 1994; 191: 1-17.
  45. Adams JH, Graham DI, Murray LS, Scott G.. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases.Ann Neurol. 1982; 12: 557-63.
  46. Steudel WI, Hacker H.. Prognosis, incidence and management of acute traumatic intracranial pneumocephalus. A retrospective analysis of 49 cases. Acta Neurochir (Wien). 1986; 80: 93-9.
  47. J. Peláez, Ma. Asensio, S. Yus, M. Sisón, M. A. Arce and M. Jiménez. Diffuse injury and age in severe closed head injury . Clinical Neurology and Neurosurgery, Volume 99, Supplement 1, July 1997, Pages S74-S75.
  48. Stein SC, Spettell CM.. Delayed and progressive brain injury in children and adolescents with head trauma.Pediatr Neurosurg. 1995; 23: 299-304..
  49. T Jouglet, P Sobraquès, O P.A.ut, B Giusiano and L Viard. Les agressions cerebrales secondaires d'origine systemique dans le traumatisme cranien de l'enfant: Frequence et valeur pronostique. Ann Fr Anesth Reanim 1998; 17: 921
  50. Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, et al. A randomized trial of very early decompressive craniotomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001; 17: 154-62.
  51. Emanuelson I, v Wendt L.. Medical management in south-west Sweden of children and adolescents with serious traumatic brain injury. Injury. 1998 ;29 :193-8.