Çocukluk çaðý kafa travmasý olgularýnda mortaliteye etki eden faktörler: Üçüncü basamak çocuk yoðun bakým ünitesi uygulamalarý

AMAÇ: Çalýþmanýn amacý, travmatik beyin hasarý nedeniyle yoðun bakým yatýþý yapýlan çocuklarda morbidite ve mortaliteye etki eden faktörleri belirlemektir.
GEREÇ VE YÖNTEM: Eylül 2014–Aralýk 2016 arasýnda 88 hasta deðerlendirildi. Glaskow koma skoruna göre üç grupta incelenen hastalarýn acil servis ve yoðun bakým süreçleri, verilen anti-ödem tedavileri, hedef serum ozmolariteye ulaþma süreleri, aksonal hasar varlýðý, entübasyon, trakeostomi oranlarý, yoðun bakým ve hastane yatýþ süreleri, Rotterdam-CT skorlamasý, travma þiddet ve PRISM–III skorlarý kayýt edildi.
BULGULAR: Yaþ arttýkça kafa travmasý þiddetinin arttýðý görüldü (p=0.010). Beyin ödemi tedavisi alan hastalarda, hedef serum ozmolariteye (ölçülen) ulaþma zamaný 8.5 (3.5–40) saat idi. ICP monitorizasyon oraný %8 olup, monitorizasyon yapýlamadýðý durumda takiplerin tekrarlayan tomografiler ile yapýldýðý ancak tedavi sürecini deðiþtirmediði saptandý. Aksonal hasarýn entübasyon, yoðun bakým ve hastane yatýþ sürelerini uzattýðý saptandý (p<0.001, p<0.001, p=0.030). Altý hastaya 14.33±1.03 günde trakeostomi açýldý; beþinin trakeostomileri ilk altý ay içinde kapatýldý.
TARTIÞMA: Mortalitenin %12.5 olduðu görüldü; hipotansiyon, akciðer kontüzyonu, travma þiddet ve Rotterdam-CT skorlarýnýn mortalite ile iliþkili idi. Rotterdam-CT skorunun sað kalýmda etkili baðýmsýz risk faktörü olduðu (p=0.001), skordaki bir birimlik artýþýn sað kalým oranýný 13.235 kat artýrdýðý (%95 GA 2.792–62.735); travma þiddet skorunun ise sýnýrda anlamlý olduðu saptandý (p=0.052; OO: 1.195 %95 GA 0.999–1.430). Beyin ölümü tanýsý alan altý hastanýn beþi hasta organ donorü oldu.

Prediction of mortality in pediatric traumatic brain injury: Implementations from a tertiary pediatric intensive care facility

BACKGROUND: To explore the mortality risk factors of traumatic brain injury in pediatric intensive care unit admissions.
METHODS: Eighty-eight children (categorized using the Glasgow Coma Scale) between September 2014 and December 2016 were analyzed. Emergency department and intensive care course, treatment strategies, axonal injury, intubation and tracheostomy rates, length of intensive care and hospitalization, Rotterdam-CT scores, injury severity scores, and PRISM-III scores were recorded.
RESULTS: Older age was associated with trauma severity (p=0.010). Target serum osmolality was reached at 8.5 (3.5–40) hours in patients undergoing anti-edema therapy. ICP-monitoring rates was 8%; in absence of ICP-monitorization clinical follow-up was performed through repeated brain tomographies. Axonal injury was associated with prolonged intubation, intensive care and hospital stay (p<0.001, p<0.001, p=0.030). Six children required tracheostomy at 14.33±1.03 days; decannulations were performed within 6 months in five children.
CONCLUSION: Mortality rate was 12.5%; six patients progressed to brain death with organ donor approvals in five. Initial hypotension, lung contusion, injury severity scores and Rotterdam-CT scores were related with mortality. Rotterdam-CT score was determined as the independent risk factor for mortality; one increment in the score increased the odd of recovery by 20.334 times (%95 CI 1.999–206.879). ISS score was also borderline significant (p=0.052; OR: 1.195 %95 CI 0.999–1.430).