Prognosis of Severe Head Injuries in Childhood and Adolescence

Abstract

In a retrospective, non-random study, the effect of supplementary medical treatment (Dexamethasone, barbiturates) was investigated upon the prognosis of severe head injuries.
Of 107 children and adolescents up to 16 years of age, 51 were treated with Dexamethasone; 56 received only standard therapy. Evaluation of the results shows that Dexamethasone therapy in high doses clearly reduced mortality in cases of severe head injuries (from 33.3 % to 13.6 %) without causing any noteworthy neurological defects. Among the individual types of injury, the effect was most evident in cases of intracranial hematoma (drop in mortality from 36.8 % to 11.8 %). On the other hand, definitive effects of therapy could not be established in the most severely injured patients with extreme brain damage and those with milder forms of trauma without substantial cerebral edema.
Barbiturates were given only when severe intracranial pressure could not be alleviated by other means. Remission was successful in a few cases but the total number is not yet sufficient for a conclusive evaluation.
Further important factors for prognosis are: depth and length of the initial disturbance of consciousness, age, concomitant injuries as well as some peculiarities of childhood and adolescence (tendency to develop severe cerebral edemas, clustering of atypical intracranial hematomas).

The high degree of motorization of traffic and the increasing role of technology in the environment during the past decades have led to a marked increase in head injuries among children and adolescents (Kretschmer 1978). The most common age group is that of the 2-6 year-old children; the greatest peak lies shortly before school age. Falls from slight heights dominate as the cause of accidents in small children; in older children and adolescents accidents occur primarily in traffic, sports, and play.
Head injuries in childhood and adolescence, compared with trauma in adulthood, display a number of peculiarities which must be kept in mind when adopting diagnostic and therapeutic measures, since they can intensely influence the further course and prognosis. These peculiarities in children primarily concern the elevated permeability of the blood-brain-barrier with increased tendency to edema, sensitivity with respect to lack of oxygen, and the easily disturbed metabolic balance (Baumann et al 1973, Kazner 1972, Schiefer 1971, Voth 1981).
In the following, we investigate how the use of newer, massive-dosed medical methods - in particular the prophylaxis and therapy of posttraumatic cerebral edema - influences the entire course.

Key words

Head injury - Cerebral edema - Hematomas - Dexamethasone