Factors affecting mortality in Pediatric Severe Head Injury

Yıl 2022, Cilt: 32 Sayı: 4, 469 - 475, 31.08.2022

Serhan Özcan , İrem Bozkurt , Seçil Akay , Oktay Perk , Emel Uyar , Harun Demirci , Pınar Özışık

https://doi.org/10.54005/geneltip.1160967

Öz

Aim: It is aimed to determine the factors affecting mortality in pediatric patients followed up with severe traumatic brain injury in the pediatric intensive care unit.
Material and method: All patients followed up in the Pediatric Intensive Care Unit between April 2019 and April 2021 due to severe traumatic brain injury were included. Demographic characteristics, pre-intensive care interventions and imaging findings, treatments applied in intensive care and intervention information of all patients were collected. Results were evaluated as survival rate, presence of tracheostomy requirement, brain death, and Pediatric Cerebral Performance Scale at discharge. The patients divided into two groups as survivors and non-survivors. All obtained data were compared between the two groups.
Results: During the study period, 47 patients with a diagnosis of severe traumatic brain injury were followed up. It was observed that the requirement of cardiopulmonary resuscitation, the need for inotrope-vasopressor and the need for erythrocyte transfusion were statistically significantly higher in the non-survivor group. (p value, respectively: 0.001, 0.001, 0.001) The survival rate in all patients in the study group was 70.2%. In non-survivor group most common pupil response at admission was fixed-dilated (71.4%). In non-survivor group 60% of the patients were lost in the first 24 hours of intensive care.
Conclusion: Mortality increases in patients who need resuscitation, erythrocyte transfusion and inotrope before intensive care. Patients who died showed pathologic pupillary response and low GCS. Severe TBH patients died mostly in first 24 hours of admission.

Anahtar Kelimeler

children, intensive care, severe head trauma

Pediatrik Ağır Travmatik Beyin Hasarında Mortaliteyi Etkileyen Faktörler

Öz

Amaç: Çocuk yoğun bakımda ağır travmatik beyin hasarı (TBH) ile izlenen pediatrik hastalarda mortaliteye etki eden faktörleri belirlemek hedeflemektedir.
Gereç ve yöntem: Çalışma geriye dönük, gözlemsel olarak planlanmıştır. Hastanemiz Çocuk Yoğun Bakım ünitesinde Nisan 2019-Nisan 2021 tarihleri arasında ağır travmatik beyin hasarı nedeniyle takip edilen tüm hastalar dahil edilmiştir. Çalışmaya alınan hastaların demografik özellikleri, yoğun bakım öncesi girişimler ve görüntülemeler, yoğun bakımda uygulanan tedaviler ve girişim bilgileri toplanmıştır. Sonuçlar yaşama oranı, trakeostomi varlığı, beyin ölümü ve taburculukta Pediatrik Serebral performans Skalası sonuçları olarak değerlendirilmiştir. Çalışmaya alınan hastalar yaşayanlar ve hayatını kaybedenler olarak iki gruba ayrıldı. Elde edilen tüm veriler iki grup arasında karşılaştırıldı.
Bulgular: Çalışma döneminde ağır travmatik beyin hasarı tanısı ile 47 hasta izlenmiştir. Hayatını kaybeden grupta kardiyopulmoner canlandırma uygulanması, inotrop-vazopressor gereksinimi ve eritosit transfüzyonu ihtiyacının istatistiksel olarak anlamlı oranda daha fazla uygulandığı görülmüştür. (p değeri sırasıyla: 0,001, 0,001, 0,001) Çalışma grubundaki tüm hastalarda yaşama oranı %70,2 olarak sonuçlanmıştır. Hayatını kaybeden hastaların yoğun bakım kabulde bakılan GKS tamamında 3 idi. Yoğun bakıma kabulde pupil yanıtı kaybedilen grupta büyük çoğunlukla fiks-dilate (%71,4) idi. Kaybedilen hastaların 60%’ı ilk 24 saatte kaybedilmiştir.
Sonuç: Yoğun bakım öncesinde canlandırma, eritrosit transfüzyonu ve inotrop ihtiyacı olan hastalarda mortalite artmaktadır. Hayatını kaybeden hastalarda patolojik pupiller yanıt ve düşük GKS olduğu görüldü. Ağır TBH olan hastalarda ölüm çoğunlukla kabülden sonraki ilk 24 saat içinde gerçekleşmiştir.

Anahtar Kelimeler

ağır kafa travması, çocuk, yoğun bakım

Kaynakça

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