Background
Methods
Inclusion criteria
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Age at time of injury between 1 and 17 years (children) or 18–55 years (adult control group).
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Date of admission from January 1, 2002, to December 31, 2012.
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Direct transport from the scene of injury to the treating hospital.
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AIS head ≥3 points.
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AIS all other body regions ≤2 points.
Injury severity and distribution
Treatment modalities
Clinical course and outcome assessment
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Death (GOS 1).
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Persistent vegetative state (GOS 2): patient exhibits no obvious cortical function.
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Severe disability (GOS 3: conscious but disabled): patient depends upon others for daily support due to mental or physical disability or both.
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Moderate disability (GOS 4: disabled but independent): patient is independent as far as daily life is concerned. The disabilities found include varying degrees of dysphasia, hemiparesis, or ataxia, as well as intellectual and memory deficits and personality changes.
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Good recovery (GOS 5): resumption of normal activities even though there may be minor neurological or psychological deficits.
Study groups
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Group I (“infants”): age 1–3 years.
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Group II (“pre-school-aged children”): age 4–6 years.
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Group III (“primary-school-aged children”): age 7–10 years.
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Group IV (“late childhood”): age 11–14 years.
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Group V (“adolescents”): age 15–17 years.
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Control Group VI (“adults”): age 18–55 years.
Statistics
Results
Age 1–3 years | Age 4–6 years | Age 7–10 years | Age 11–14 years | Age 15–17 years | Adults | |
---|---|---|---|---|---|---|
n
| 118 | 127 | 193 | 270 | 402 | 6491 |
Age [mean (SD)] | 2.1 (0.8) | 5.0 (0.8) | 8.4 (1.1) | 12.7 (1.1) | 16.1 (0.8) | 36.5 (11.7) |
Male (%) | 56.4 | 63.8 | 61.8 | 59.9 | 67.2 | 76.6 |
ISS (points) | 20.3 (14.1) | 18.6 (11.8) | 17.0 (7.3) | 18.1 (8.2) | 19.4 (9.7) | 20.2 (10.8) |
GCS on-scene (points) | 9.6 (4.5) | 9.7 (4.6) | 10.5 (4.3) | 9.3 (4.5) | 9.4 (4.7) | 9.6 (4.7) |
Head injury severity | Age 1–3 years (%) | Age 4–6 years (%) | Age 7–10 years (%) | Age 11–14 years (%) | Age 15–17 years (%) | Adults (%) |
---|---|---|---|---|---|---|
AIS 3 | 32.2 | 40.9 | 45.6 | 42.6 | 38.9 | 37.1 |
AIS 4 | 42.4 | 39.4 | 39.9 | 35.6 | 35.9 | 32.3 |
AIS 5 | 20.3 | 16.5 | 14.0 | 21.1 | 23.5 | 28.3 |
AIS 6 | 5.1 | 3.1 | 0.5 | 0.7 | 1.7 | 2.4 |
Age 1–3 years (%) | Age 4–6 years (%) | Age 7–10 years (%) | Age 11–14 years (%) | Age 15–17 years (%) | Adults (%) | |
---|---|---|---|---|---|---|
Car | 14.6 | 18.3 | 10.3 | 5.9 | 15.6 | 23.3 |
Motorcycle | 1.0 | 0 | 0.5 | 2.4 | 23.7 | 9.3 |
Bicycle | 0 | 8.3 | 19.0 | 27.3 | 15.1 | 12.4 |
Pedestrian | 9.7 | 17.5 | 28.3 | 23.3 | 11.2 | 6.4 |
Low fall <3 m | 27.2 | 22.5 | 14.7 | 15.8 | 11.2 | 20.6 |
High fall >3 m | 29.1 | 15.0 | 17.4 | 9.9 | 8.1 | 14.3 |
Age 1–3 years | Age 4–6 years | Age 7–10 years | Age 11–14 years | Age 15–17 years | Adults | |
---|---|---|---|---|---|---|
Overall mortality (%) | 17.8* | 15.6* | 7.0 | 10.4 | 9.3 | 13.7 |
Mortality AIS head >5 (%) | 50.9*#
| 52,4*#
| 29.6 | 31.6 | 32.6 | 33.4 |
Low disability (GOS = 5) (%) | 64.4 | 60.6 | 71.5 | 63.3 | 55.4 | 48.0 |
Severe disability (GOS 2 and 3) (%) | 5.0 | 7.0 | 8.3 | 10.7 | 12.4 | 17.3 |
ICU (days, survivors) | 6.0 (11.7) | 4.9 (6.1) | 5.5 (8.5) | 5.5 (7.0) | 8.3 (11.4) | 8.2 (10.8) |
Ventilator days (survivors) | 2.5 (5.2) | 2.6 (5.2) | 2.7 (5.2) | 3.3 (6.1) | 5.2 (9.3) | 5.1 (9.1) |
Hospital stay (days, survivors) | 13.2 (16.1) | 11.6 (11.8) | 12.1 (10.9) | 11.7 (8.0) | 17.7 (23.5) | 17.0 (20.8) |
Sepsis (%) | 2.2 | 3.3 | 0.7 | 2.6 | 6.4 | 5.9 |
MOF (%) | 16.1 | 18.2 | 17.2 | 15.0 | 19.3 | 23.5 |
SMR |
Age 1–3 years | Age 4–6 years | Age 7–10 years | Age 11–14 years | Age 15–17 years | Adults | |
---|---|---|---|---|---|---|
Intubation on-scene (%) | 14.4 | 8.6 | 8.4 | 7.6 | 11.3 | 10.4 |
GCS ≤8 and intubation on-scene | 74.5 | 87.5 | 89.4 | 94.1 | 88.4 | 87.7 |
Intubation at ER (%) | 43.3 | 60.0 | 59.0 | 61.4 | 65.2 | 58.4 |
Cranial CT scan (%) | 89.9 | 91.3 | 92.7 | 97.4 | 96.3 | 95.3 |
Whole-body CT scan (%) | 32.5 | 34.1 | 40.3 | 34.9 | 50.0 | 56.2 |
Discharged home (%) | 59.3 | 58.3 | 67.9 | 59.6 | 50.7 | 43.8 |
Craniotomy (%) | 9.4 | 9.2 | 8.0 | 10.5 | 9.8 | 11.8 |
Transfer to a rehabilitation clinic (%) | 15.3 | 15.7 | 16.6 | 21.1 | 27.6 | 29.0 |
Other hospital (%) | 5.9 | 7.9 | 6.2 | 8.5 | 10.7 | 11.3 |
Discussion
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The initial treatment and diagnostics (rate of intubation and cranial CT scan) showed no relevant differences between the different age groups; however, children were less frequently transferred to rehabilitation centres.
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The mortality rate was significantly higher in children younger than 7 years, especially after severe TBI.
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Functional outcome after TBI was better for children in comparison to adolescents and adults, even after severe TBI.