[Epidemiology of severe cranial injuries in children and the prognosis of injured patients hospitalized in neurosurgery units].

Abstract

Over five years (1979-1983), 1,058 children who sustained injuries in the Val de Marne District (near Paris) were treated by the Emergency and Intensive Care Mobile Unit. Among these patients, 17.8% had an isolated, severe head injury (Glasgow score less than 12) and were admitted to a neurosurgical unit; the age and sex distribution in this group was comparable to that of the entire group of injured children (2/3 boys). The severe head injury was caused by a motor vehicle accident in 47% of cases and a fall in 34% of cases. One half of patients had a skull fracture; all patients with an extra-dural (14 cases) or sub-dural (7 cases) hematoma had a skull fracture. Seventy per cent of patients had cerebral edema and 25% had a meningeal hemorrhage. Immediate severe neurologic disorders (Glasgow score less than 9) were present in 53% of cases and 27% of patients had focal neurologic signs. Mean duration of the stay in the neurosurgical unit was 6 to 15 days. Mortality was 15.3%; in most cases (75%) death occurred within the first 48 hours. One-year morbidity was very significant; 67% of surviving children had residual disease, and 40% had severe sequelae.