Original Research Article
Year: 2020 | Month: February | Volume: 10 | Issue: 2 | Pages: 37-42
Head Injury in Children: A Tertiary Care Centre Study
Shyamendra Pratap Sharma1, Nitya Nand Gopal2
1Senior Resident, Department of Pediatric Surgery, Institute Of Medical Sciences, Banaras Hindu University, Varanasi, India
2Professor, Neurosurgery unit of Department of General Surgery, S.R.N. Hospital associated with M.L.N Medical College, Allahabad
Corresponding Author: Shyamendra Pratap Sharma
ABSTRACT
Aim and objective: To investigate various prognostic factors associated and their effect on the neurological outcome among children with a head injury on the basis of mode of injury, GCS at time of admission, pupillary response, hypoxia, CT scan findings and time of surgical intervention.
Methods: This was a prospective observational study of thirty-four children (age<15 years) with a head injury, managed in the P.G. Department of surgery, S.R.N. Hospital associated with M.L.N Medical college, Allahabad from September 2015 to August 2016 a period of 12 months. The factors affecting the outcome were analyzed.
Results: Out of the 34 children, there were 7 children less than 5 years and 27 were above 5 years of age. Poor outcome was seen in 42.8% children below 5 years, 35.7% in 6-10 years group, 15.3% in 11-15 years group. Male: female ratio was approximately 1:2. There were 4 patients in GCS of 3-8, of which 3 (75%) had a poor outcome; while out of 12 patients of GCS 9-12, 7 (58.3%) had poor outcome. Out of 18 patients in GCS 13-15, no patient had poor outcome. Twelve patients had abnormality of pupillary size and reaction, poor outcome was seen in 58.33% in contrast to only 13.6% with normal pupillary response. There were 12 patients with acute subdural hematoma, 5 patients had contusion, extradural hematoma in 11 patients, subarachnoid haemorrhage in 1 patient and multiple brain injuries in 5 patients. Poor outcome was noticed in 80% patients with multiple brain injuries, 20% with contusion, 18.18% with acute subdural hematoma and 16.6% with extradural hematoma. Poor outcome noticed in 63.6% patients with midline shift > 5mm. Non-operated patients had poor outcome (45.4%) than operated patients (21.7%). Poor outcome was noticed in 23.5% patients operated after 24 hour and 16.6% patients operated within 24 hour (Table 3). Overall poor outcome was seen in 10 (29.4%) of 34 children with head injury.
Conclusion: The unfavorable prognostic factors for traumatic intracranial hematoma are RTA, low GCS (3-8), nonresponsive pupil to light, presence of multiple lesion on CT scan, midline shift > 5 mm, nonoperative lesions, the time elapsed from trauma to surgery > 24 hours.
Key words: Head injury; Glasgow coma scale; Intracranial hematoma; Glasgow outcome scale