Resumo

LOPEZ ALVAREZ, J.M. et al. Severe pediatric head injuries (I): Epidemiology, clinical manifestations and course. Med. Intensiva [online]. 2011, vol.35, n.6, pp.331-336. ISSN 0210-5691.

Objective: To describe the epidemiology, clinical manifestations and evolutive characteristics of pediatric patients with severe head injury (SHI). Material and method: A review was made of the patients admitted to the pediatric intensive care unit (PICU) with SHI between July 1983 and December 2009. Results: Of the 389 patients with head injuries admitted to the PICU during the study period, 174 (45%) presented SHI. The mean age in this group was of 67±9 months, with a Glasgow Coma Score (GCS) of 5.5±1.8 and a PRISM score of 10.7±6.7. The most frequent etiology of SHI was traffic accidents (56%), though these have decreased significantly in the last decade (58.5% vs 45.3%; P<.001). Twenty-one percent of the patients required evacuation of the lesions detected by computed tomography (CT), and 39% presented severe diffuse encephalic injury (DEI). Seventy-nine percent of the patients in whom intracranial pressure (ICP) was monitored presented intracranial hypertension. Sequelae of clinical relevance were recorded in 59 patients (39%), and proved serious in 64% of the cases. The mortality rate in this patient series was 24.7%. Intracranial hypertension decreased significantly in the last decade (88% vs 54%; P<.05), and clinical recovery has improved (23.3% vs 63.1%; P<.001). Conclusions: a) The incidence of traffic accidents has decreased in the last decade in the studied population; b) patients with SHI in which ICP was monitored showed a high incidence of intracranial hypertension; c) morbidity-mortality among pediatric patients with SHI has decreased over the course of the study period.

Palavras-chave : Pediatric head injury; Epidemiology; Clinical manifestations; Evolution.

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