DOI QR코드

DOI QR Code

Predictors of Outcome in Management of Paediatric Head Trauma in a Tertiary Healthcare Institution in North-Central Nigeria

  • Gyang Markus Bot (Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Danaan J. Shilong (Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Jerry A. Philip (Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Ezekiel Dido Dung (Division of Paediatric Surgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Andrew H. Shitta (Division of Paediatric Surgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Nanpan Isa Kyesmen (Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Jeneral D. Alfin (Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Lena Mary Houlihan (The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center) ;
  • Mark C. Preul (The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center) ;
  • Kenneth N. Ozoilo (Division of Trauma Surgery, Department of Surgery, Jos University Teaching Hospital) ;
  • Peter O. Binitie (Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital)
  • 투고 : 2022.02.08
  • 심사 : 2022.10.12
  • 발행 : 2023.09.01

초록

Objective : Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. Methods : We examined our institutional Trauma Registry over a 2 year period. Results : A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Conclusion : Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.

키워드

과제정보

Thanks to the families with whom we worked. We wish to also thank Mr. Kopse Seyilnen for helping with the statistical analysis.

참고문헌

  1. Adelson PD, Kochanek PM : Head injury in children. J Child Neurol 13 : 2-15, 1998  https://doi.org/10.1177/088307389801300102
  2. Agrawal A, Agrawal CS, Kumar A, Lewis O, Malla G, Khatiwada R, et al. : Epidemiology and management of paediatric head injury in Eastern Nepal. Afr J Paediatr Surg 5 : 15-18, 2008  https://doi.org/10.4103/0189-6725.41630
  3. Bell MJ, Adelson PD, Wisniewski SR; Investigators of the ADAPT Study : Challenges and opportunities for pediatric severe TBI-review of the evidence and exploring a way forward. Childs Nerv Syst 33 : 1663-1667, 2017  https://doi.org/10.1007/s00381-017-3530-y
  4. Chinda JY, Abubakar AM, Umaru H, Tahir C, Adamu S, Wabada S : Epidemiology and management of head injury in paediatric age group in North-Eastern Nigeria. Afr J Paediatr Surg 10 : 358-361, 2013  https://doi.org/10.4103/0189-6725.125448
  5. Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, et al. : Surveillance for traumatic brain injury-related deaths--United States, 1997-2007. MMWR Surveill Summ 60 : 1-32, 2011 
  6. Dewan MC, Mummareddy N, Wellons JC 3rd, Bonfield CM : Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg 91 : 497-509.e1, 2016  https://doi.org/10.1016/j.wneu.2016.03.045
  7. Emejulu JK, Shokunbi MT : Aetiological patterns and management outcome of paediatric head trauma: one-year prospective study. Niger J Clin Pract 13 : 276-279, 2010 
  8. Kochanek PM, Tasker RC, Bell MJ, Adelson PD, Carney N, Vavilala MS, et al. : Management of pediatric severe traumatic brain injury: 2019 consensus and guidelines-based algorithm for first and second tier therapies. Pediatr Crit Care Med 20 : 269-279, 2019  https://doi.org/10.1097/PCC.0000000000001737
  9. Nnadi MO, Bankole OB, Fente BG : Epidemiology and treatment outcome of head injury in children: a prospective study. J Pediatr Neurosci 9 : 237-241, 2014  https://doi.org/10.4103/1817-1745.147577
  10. Odebode TO, Abubakar AM : Childhood head injury: causes, outcome, and outcome predictors. A Nigerian perspective. Pediatr Surg Int 20 : 348-352, 2004  https://doi.org/10.1007/s00383-004-1196-5
  11. Osifo OD, Iribhogbe PE, Ugiagbe EE : Epidemiology and pattern of paediatric and adolescent trauma deaths in a level 1 trauma centre in Benin city, Nigeria. Injury 43 : 1861-1864, 2012  https://doi.org/10.1016/j.injury.2011.07.016
  12. Shi J, Xiang H, Wheeler K, Smith GA, Stallones L, Groner J, et al. : Costs, mortality likelihood and outcomes of hospitalized US children with traumatic brain injuries. Brain Inj 23 : 602-611, 2009  https://doi.org/10.1080/02699050903014907
  13. Stanley RM, Bonsu BK, Zhao W, Ehrlich PF, Rogers AJ, Xiang H : US estimates of hospitalized children with severe traumatic brain injury: implications for clinical trials. Pediatrics 129 : e24-e30, 2012  https://doi.org/10.1542/peds.2011-2074
  14. Udoh DO, Adeyemo AA : Traumatic brain injuries in children: a hospitalbased study in Nigeria. Afr J Paediatr Surg 10 : 154-159, 2013  https://doi.org/10.4103/0189-6725.115043
  15. Vaghani G, Singh PK, Gupta DK, Agrawal D, Sinha S, Satyarthee G, et al. : Outcome of patients with traumatic head injury in infants: an institutional experience at level 1 trauma center. J Pediatr Neurosci 8 : 104-107, 2013 https://doi.org/10.4103/1817-1745.117836