Traumatismo de cráneo grave en niños: Seguimiento interdisciplinario

Walter Pérez; Silvia Muñoz; Alicia  García; Laura De Castelet; Estrella Arigón; Aurora Fuentes; Gabriel González; Andrea Rey; Gladis Curbelo

Authors

Walter Pérez Hospital Pereira Rossell, Unidad de Cuidados Intensivos del Niño, ex Prof. Adj. Clínica Pediátrica, ex Prof. Adj.
Silvia Muñoz Hospital Pereira Rossell, Unidad de Cuidados Intensivos del Niño, Pediatra Intensivista
Alicia García Hospital Pereira Rossell, Unidad de Cuidados Intensivos del Niño, Clínica Pediátrica B, Prof. Adj.
Laura De Castelet Hospital Pereira Rossell, Fisiatría, Prof. Agdo.
Estrella Arigón Hospital Pereira Rossell, Fisiatría, Ex Asistente
Aurora Fuentes Hospital Pereira Rossell, Psiquiatría Infantil, Ex Asistente
Gabriel González Hospital Pereira Rossell, Neuropediatría, Prof. Adj.
Andrea Rey Hospital Pereira Rossell, Neuropediatría, Asistente
Gladis Curbelo Centro Hospitalario Pereira Rossell, Asistente Social

Keywords:

CRANIOCEREBRAL TRAUMA, CHILD

Abstract

Traumatic brain injury is the most frequent cause of neurologic sequelae and death in children. Technology and wider comprehension of physiopathologic processes have contributed to increase survivors rate, who need multidisciplinary and sustaintable rehabilitation.
The group works on the basis of a polivalent protocol follow up program since patients with severe TBI entry in Pediatrics Intensive Care Unit (UCIN).
During four years 50 patients were controlled in an ambulatory way. Median of follow up duration was 20 months. Median of ages was 9 years. Traffic was the most frequent cause of TBI. Other traumatisms were seen in 50% of the group. Fifty percent endured surgical operations; half of them underwent urgent neurosurgery. Initial comma was observed in 95%. More than 90% presented pathologic TBI with fractures, bruise and subarachnoid hemorrhage, as the most frequent.
At released, 78% patients presented severe deficiencies related to the accident. The most frequent were those related to cognitive and locomotive areas. According to the Glasgow Outcome Scale (GOS) 22% of the patients were released from hospital under vegetative state, but showed functional recovery during the following months. Prevalence of motor and cognitive sequelae decreased, but psychological sequelae increased during follow up. Three patients died during follow up.
Type of sequelae vary according to fases of follow up, locomotive and psychological sequelae were the most affected in long-term. Persistance of vegetative state was not frequent but was a death risk after onset. GOS was a useful tool to assess neurologic commitment in follow up.

References

1) Hawthorne VM. Epidemiology of head injuries. Scot Med J 1975; 23(1): 92.
2) Jennett B, MacMillan R. Epidemiology of head injury. Br Med J (Clin Res Ed) 1981; 282(6258): 101-4.
3) Pardo L, Muñoz S, Sirio E, Lezama G, Ramírez M, Pérez W, et al. Traumatismo de cráneo en Pediatría. Parámetros clínicos y radiológicos asociados con alteraciones tomográficas. Estudio prospectivo. Arch Pediatr Urug 1996; 67(4): 31.
4) Parker RS, Abdel-Dayem H, Silverman SI, Hutchinson M, Luciano D, Minagar A. A Protocol for Multidisciplinary Assessment of the Outcome of Traumatic Brain Injury in Adults after Two Years or More. [Miscellaneous].Top Emerg Med 2001; 23(4): 57-84.
5) Dikmen S, McLean AJr, Temkin NR, Wyler AR. Neuropsychologic outcome at one month post injury. Arch Phys Med Rehabil 1986; 67(8): 507-13.
6) Dacey R, Dikmen S, Temkin N, McLean A, Armsden G, Winn HR. Relative effects of brain and non-brain injuries on neuropsychological and psychosocial outcome. J Trauma 1991; 31(2): 217-22.
7) Pérez W, Muñoz S, Bossio M, Guillén W, García A, Alberti M, et al. Traumatismo de cráneo grave en cuidados intensivos pediátricos. Arch Pediatr Urug 2001; 72(1): 38-44.
8) King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 1995; 242(9): 587-92.
9) Ruff RM, Levin HS, Marshall LF. Neurobehavioral methods of assessment and the study of outcome in minor head injury. J Head Trauma Rehabil 1986; 1: 43-52.
10) Barth JT, Macciocchi SN, Giordani B, Rimel R, Jane JA, Boll TJ. Neuropsychological sequelae of minor head injury. Neurosurgery 1983; 13(5): 529-33.
11) Bohnen N, Jolles J, Twijnsta MD. Neuropsychological deficits in patients with persistent symptoms six months after mild head injury. Neurosurgery 1992; 30(5): 692-6.
12) Moss NEG, Crawford S, Wade DT. Post-concussion symptoms: is stress a mediating factor? Clin Rehabil 1994; 8: 149-56.
13) Russell WR, Smith A. Post traumatic amnesia after closed head injury. Arch Neurol 1961; 5: 16-29.
14) Lishman WA. Physiogenesis and psychogenesis in the "post-concussional syndrome". Br J Psychiatry 1988; 153: 460-9.
15) Evans RW. The post concussion syndrome and the sequelae of head injury. Neurol Clin 1992; 10(4): 815-47.
16) Collin C, Wade DT, Davis S, Horne V. The Barthel ADL index: a reliability study. Int Disabil 1988; 10: 61-3.
17) McCauley SR, Levin HS, Vanier M, Mazaux J-M, Boake C, Clifton GL. The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment. J Neurol Neurosurg Psychiatry 2001; 71(5): 643-51.
18) Brown SA, McCauley SR, Levin HS, David Clifton GL. Factor Analysis of an Outcome Interview for Use in Clinical Trials of Traumatically Brain-Injured Patients: A Preliminary Study. Am J Phys Med Rehabil 2001; 80(3): 196-205.