Traumatismo craneoencefálico grave en el paciente pediátrico. Evaluación de la neuroimagen y monitorización de la presión intracraneal como factores pronóstico

Aims. To evaluate the use of the neuroimage (Traumatic Coma Data Bank scale) and intracranial pressure as prognostic factors of morbimortality in paediatric patients with severe head injury. Material and methods. Study of patients admitted to a Paediatric Intensive Care Unit with severe head injury and monitorization of intracranial pressure in the period between January 1995 and June 1998. Results. Among the 242 paediatric patients, aged three to 18 years, observed during the study period, 64 needed invasive intracranial pressure monitoring. The most frequent neuro-image pattern, at first CT, was LED II (43.8%), followed by LED III (29.7%), VI (12.5%) and LED I (9.4%). We have found a linear association between the findings of the first CT and maximum intracranial pressure and minimum cerebral perfusion pressure over the first two hours of follow up. These parameters were also significantly correlated with prognosis and there was evidence of a statistically significant relationship between the first CT and clinical evolution (p < 0.001). Most of the cases (73.5%) had a good recovery, 18.8% had no sequelae and the remainder suffered minor psycological or motor disorders. The mortality rate was 10.9% and the percentage with incapacitating sequelae was 15.9%. Conclusions. Computerised tomography and intracranial pressure monitorization provide important prognostic predictors of severe head injury in children. The Traumatic Coma Data Bank scale allows an early identification of patients with high risk of intracranial hypertension also in paediatric patients. The absence of visible pathology in first CT does not rule out the possibility of a subsequent episode of intracranial hypertension and therefore it is advisable to check intracranial pressure should the Glasgow Coma Scale score be less than or equal to eight, even if the first CT is normal.