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Vol. 1. Issue 3.
Pages 145-152 (January 1990)
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Vol. 1. Issue 3.
Pages 145-152 (January 1990)
Resultados y factores pronósticos del traumatismo craneoencefálico severo en la edad pediátrica
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J. Esparza, F. Cordobes, J.M. Portillo, J.A. Yuste, M. Castañeda, E. Lamas
Neurocirugía y Anestesia Pediátricas. Hospital Infantil «12 de Octubre». Facultad de Medicina. Universidad Complutense. Madrid
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Resumen

Presentamos una serie de 112 niños (edad media 7,6 años), con traumatismo craneoencefálico (TCE), y que ingresaron en el hospital con puntuación en la Escala de Glasgow (EG) inferior a 8. Todos ellos fueron tratados en base a un protocolo de tipo «agresivo», con monitorización continua de la presión intracraneal (PIC). Se han analizado fundamentalmente el tipo de lesión en la Tomografía Axial Computarizada (TAC), los rangos de PIC, la edad, y la severidad del TCE según la EG.

Las lesiones cerebrales postraumáticas focales, tal como se vieron en la TAC, representaron un 39,3 % y tuvieron peor pronóstico que las difusas (60,7 %). El tipo de lesión denominado «Diffuse Brain Swelling» fue el de mejor pronóstico y el más frecuente, mientras que los hematomas extracerebrales con lesión asociada fueron los de peor evolución. La hipertensión intracraneal (48,2 % de los casos) fue un índice de muy mal pronóstico, sobre todo en niveles superiores a 40mmHg. La edad inferior a 5 años comportó un mal pronóstico, y el 40 % de los casos con baja puntuación al ingreso en la EG se recuperó, por lo que su valor como factor pronóstico fue discutible. La mortalidad global de la serie (32 %) es similar a la de la mayoría de los autores con series homologables.

Palabras clave:
Trauma craneal
Edad pediátrica
PIC
TAC
Pronóstico
Summary

We present a series of 112 severe head injury children (mean age 7,6 years)), that were managed according to an «agressive» protocol with monitoring of ICP. The type of lesion, age, ICP an Glasgow coma score were specially analyzed.

Postraumatic focal brain lesions as seen on CT-scan (39,3 %) had a worse outcome than diffuse brain damage (60,7 %). Diffuse Brain Swelling was the most frequent lesion and children with this type of injury had a good outcome. Patientswith extracerebral hematomas and associated lesions had a poor prognosis. Increased intracranial pressure was found in 48,2 % of the cases and sustained severe intracranial hypertension was an index of poor outcome. There was also a higher mortality among the infants, mostly in those with low level of conscioussnes. Forty per cent of children with low GCS score at admission recovered. Thus, it seems that CGS is not an absolute prediction factor in this analysis. Global mortality rate was 32 % in this series, a number similar to others reported in the neurosurgical literature.

Key words:
Head Trauma
Children
ICP
CT-Scan
Outcome

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