Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry

Lichte et al. Eur J Med Res Increased in-hospital mortality following severe head injury in young children: results from a nationwide trauma registry Philipp Lichte 0 Hagen Andruszkow 0 Miriam Kappe 0 Klemens Horst 0 2 Miguel Pishnamaz 0 2 Frank Hildebrand 0 Rolf Lefering 1 Hans‑Christoph Pape 0 Philipp Kobbe 0 TraumaRegister DGU 0 Department of Orthopaedic Trauma Surgery, University Hospital Aachen , Pauwelsstraße 30, 52074 Aachen , Germany 1 Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke , Ostmerheimer Str. 200, 51109 Cologne , Germany 2 Harald Tscherne Research Labo‐ ratory for Orthopedic Trauma, Department of Orthopaedic Trauma Surgery, University Hospital RWTH Aachen , Aachen , Germany 3 Committee on Emergency Medicine, Intensive Care and Trauma Management, German Trauma Society (Sektion NIS) , Cologne , Germany Background: In the current literature, the outcome of paediatric brain injury is controversially discussed. According to the majority of the studies, there seems to be a decreased mortality but worse recovery in paediatric, traumatic brain injury in comparison with adults. However, there is a lack of information concerning the differences in various stages of development in patients younger than 18 years. The aim of our study was to verify the in‑ hospital outcome of different paediatric age groups in comparison to adults with respect to the treatment strategy. Methods: We performed a retrospective analysis of the TraumaRegister DGU® from 2002 to 2012. Inclusion criteria were an Abbreviated Injury Scale (AIS) head ≥3 points and an AIS ≤2 points of the remaining body regions. The collective was divided into different subgroups according to age (1-3, 4-6, 7-10, 11-14, 15-17) and an adult control group aged between 18 and 55 years. We descriptively analysed the endpoint rate of sepsis, multiple organ failure, and mortality. Additionally, the Glasgow Outcome Scale (GOS) at discharge was observed. Results: Overall, 1110 children and 6491 adult control patients were included. Comparing the rate of intubation on‑ scene, the rate of cranial CT scans, the rate of craniotomies, and the rate and length of intensive care treatment, we could only identify minor differences between the age groups. The treatment after discharge from hospital was markedly different due to a very low rate of in‑ patient rehabilitation treatment in children. On one hand, the rate of systemic complications, such as sepsis and multiple organ failure increased with increasing age. On the other hand, we found a significantly increased mortality in children younger than 7 years after very (AIS head = 5) severe brain injury. The in‑ hospital functional outcome in survivors, according to the GOS, was beneficial for younger children in comparison to adolescents and adults. Conclusions: We were unable to identify marked age‑ related differences in the therapeutic approach. Nevertheless, we were able to demonstrate marked differences of outcome. Children younger than 7 years significantly die more often due to direct impact of severe trauma. But if they survive, they seem to develop less systemic complications and profit from a better functional outcome. - Background Traumatic brain injury (TBI) is a major determinant of morbidity and mortality in trauma patients [1, 2]. In Germany, the overall incidence of TBI was reported to be approximately 332/100,000 inhabitants per year [3]. Despite a comparable incidence of TBI in children and adults, TBI represents the leading cause of death in children aged under 15 years [4]. In general, there seem to be significant differences between children and adults in the clinical course after TBI. In this context, children are supposed to be more capable to adapt to brain injury and demonstrate a lower mortality rate [5]. However, another study also indicated © 2015 Lichte et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. that there might be an inverse correlation between age and remaining neurological deficit [6]. Thus, information on a potential, favourable outcome following TBI in children or adolescents compared to adults seems to be controversial in the current literature. Different aspects might cause this lack of consent. Besides small sample sizes, an “aged-matched” prediction of morbidity and mortality might be further complicated by multiple interacting factors, such as overall injury severity, in-hospital treatment strategies, a (...truncated)