Trauma craneoencefálico: Factores de riesgo de mortalidad en pacientes de 2 a 15 años | Traumatic head injury: Risk factors of mortality in 2 to 15 years old patients
Resumen
El trauma craneoencefálico presenta una incidencia elevada y continúa siendo una de las principales causas de muerte y discapacidades permanentes en niños. Para identificar factores de riesgo de mortalidad en niños entre 2 y 15 años de edad con traumatismo craneoencefálico, se realizó un estudio observacional, analítico, prospectivo, donde se incluyeron 204 pacientes con trauma craneoencefálico con Escala de Coma Glasgow (GCS) menor de 13 puntos, divididos según la supervivencia. La mortalidad fue del 17,2%. En el análisis univariable, las características asociadas a mortalidad fueron: GCS < 9 puntos, PRISM (Pediatric Risk of Mortality) > 20 puntos, PTS (Pediatric Trauma Score) < 4 puntos, shock, coagulopatía, hipotermia, hipercapnia, anemia, hemorragia subaracnoidea, edema cerebral, lesión de tallo cerebral y diabetes insípida. Mediante regresión logística binaria se identificó como factores de riesgo para mortalidad por trauma craneoencefálico en niños: PRISM > 20 puntos (OR = 4,1; 95% IC: 1,9 - 14,3; p = 0,049), PTS < 4 puntos (OR = 3,9; 95% IC: 2,3- 18,1; p = 0,015), shock (OR = 5,0; 95% IC: 2,3 - 22,4; p = 0,035), coagulopatía (OR = 3,2; 95% IC: 2,1- 16,7; p = 0,016) y congestión vascular cerebral (OR = 4,2; 95% IC: 2,1 - 15,7; p = 0,029). El PRISM y el PTS son herramientas fiables para predecir mortalidad en niños con trauma craneoencefálico. El shock, la coagulopatía y el edema cerebral son lesiones secundarias que deben ser prevenidas y tratadas para mejorar la sobrevida en este grupo de pacientes.
Palabras clave: PRIMS, escala de trauma pediátrico, coagulopatía, congestión vascular cerebral.
ABSTRACT
Traumatic head injury has a high incidence and continues being a major cause of death and permanent disabilities in children. To identify risk factors for mortality in children between 2 and 15 years of age with traumatic brain injury, , an observational, analytical, prospective study was conducted , which enrolled 204 patients with GCS (Glasgow Coma Scale) under 13 points, divided according to survival. Mortality was 17.2%. In univariate analysis, the characteristics associated with mortality were: GCS < 9 points, PRISM (Pediatric Risk of Mortality) > 20 points, PTS (Pediatric Trauma Score) < 4 points, shock, coagulopathy, hypothermia, hypercapnia, anemia, subarachnoid hemorrhage, cerebral swelling, brain stem injury and diabetes insipidus. Through binary logistic regression, the risk factors of mortality for traumatic head injury in children were identified as: PRISM > 20 (OR = 4.1; CI 95%: 1.9 - 14.3; p = 0.049), PTS < 4 points (OR = 3.9; CI 95%: 2.3 - 18.1; p = 0.015), shock (OR = 5.0; CI 95%: 2.3 - 22.4; p = 0.035), coagulopathy (OR = 3.2; CI 95%: 2.1 - 16.7; p = 0.016) and cerebral swelling (OR = 4.2; CI 95%: 2.1 - 15.7; p = 0.029). PRISM and PTS are reliable tools to predict mortality in children with traumatic brain injury. Coagulopathy, shock and cerebral swelling are secondary lesions that must be prevented and treated to improve survival in this group of patients.
Key words: PRISM, pediatric trauma score, coagulopathy, cerebral swelling.
Referencias
CALLAND JF, XIN W, STUKENBORG GJ. 2013. Effects of leading mortality risk factors among trauma patients vary by age. J. Trauma Acute Care Surg. 75(3):501-505.
CHELLY H, GARGOURI R, DAMMAK H, KALLEL H. 2009. Traumatic head injury in children in south Tunisia epidemiology, clinical manifestations and evolution: 454 cases. Tunis Med. 87(1):28-37.
DAVENPORT R. 2013. Pathogenesis of acute traumatic coagulopathy. Transfusion. 53(Suppl. 1):23S-27S.
FLOCCARD B, RUGERI L, FAURE A. 2012. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury. 43(1):26-32.
HAIDER AH, HASHMI ZG, ZAFAR SN, CASTILLO R, HAUT ER, SCHNEIDER EB, CORNWELL EE, MACKENZIE EJ, EFRON DT. 2014. Developing best practices to study trauma outcomes in large databases: An evidence-based approach to determine the best mortality risk adjustment model. J. Trauma Acute Care Surg. 76(4): 1061-1069.
HORAN MJ, BONITA F, KIMM SY. 1987. Report on the Second Task Force on Blood Pressure Control in Children. Pediatrics. 79(1):1-25.
JENNETT B, BOND M. 1975. Assessment of outcome after severe brain damage. Lancet. 1(7905):480-484.
KOCHANEK PM, CARNEY N, ADELSON PD, ASHWAL S, BELL MJ, BRATTON S, CARSON S, CHESNUT RM, GHAJAR J, GOLDSTEIN B, GRANT GA, KISSOON N, PETERSON K, SELDEN NR, TASKER RC, TONG KA, VAVILALA MS, WAINWRIGHT MS, WARDEN CR. 2012. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Pediatr. Crit. Care Med. 13(Suppl. 1): S1-S82.
LEONG BK, MAZLAN M, RAHIM RB, GANESAN D. 2013. Concomitant injuries and its influence on functional outcome after traumatic brain injury. Disabil. Rehabil. 35(18):1546-1551.
LÓPEZ JM, VALERÓN ME, PÉREZ O, LIMIÑANA JM, JIMÉNEZ A, CONSUEGRA E, MORÓN A, GONZÁLEZ R. 2011. Severe pediatric head injuries (II): factors associated to morbidity-mortality. Med. Intensiva. 35(6):337-343.
MARSHALL L. 1991. A new classification of head injury based on computerized tomography. J. Neurosurgery. 75(Suppl):S14- S20.
RHINE T, WADE SL, MAKOROFF KL, CASSEDY A, MICHAUD J. 2012. Clinical predictors of outcome following inflicted traumatic brain injury in children. J. Trauma Acute Care Surg. 73(4):S248-S253.
SARTORIUS D, LE MANACH Y, DAVID JS, RANCUREL E, SMAIL N, THICOÏPÉ M, SARTORIUS D, LE MANACH Y, DAVID J, RANCUREL E, SMAIL N, THICOIPE M, WIEL E, RICARD-HIBON A, BERTHIER F, GUEUGNIAUD PY, RIOU B. 2010. Mechanism, Glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit. Care Med. 38(3):831-837.
SETTERVALL CH, DOMINGUES CA, SOUSA RM, NOGUEIRA LS. 2012. Preventable trauma deaths. Rev. Saúde Pública. 46(2):367-375.
TUDE MELO JR, DI ROCCO F, BLANOT S. 2010. Mortality in children with severe head trauma: predictive factors and proposal for a new predictive scale. Neurosurgery. 67(6):1542-1547.
VAVILALA MS, KERNIC MA, WANG J, KANNAN N, MINK RB, WAINWRIGHT MS, GRONER JI, BELL MJ, GIZA CC, ZATZICK DF, ELLENBOGEN RG, BOYLE LN, MITCHELL PH, RIVARA FP, PEDIATRIC GUIDELINE ADHERENCE AND OUTCOMES STUDY. 2014. Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med. 42(10):2258-2266.
VIOLAKI A, SALPIGIDOU K, CHARALAMPOPOULOS D, HOCHILIOUROU E, KIRITSI E, DIMITRIADOU M. 2014. Prognostic factors and outcome of traumatic brain injury in children treated in Picu. Arch. Dis. Child. 99:A343.
YUAN F, DING J, CHEN H. 2012. Predicting outcomes after traumatic brain injury: the development and validation of prognostic models based on admission characteristics. J. Trauma Acute Care Surg. 73(1):137-145.
ZIAEE M, MIRAFZAL A. 2016. Association of base deficit with mortality in pediatric trauma. J. Emerg. Practice Trauma. 2(2):50-54.
Texto completo:
PDFReferencias
Enlaces refback
- No hay ningún enlace refback.
