Análise de fatores relacionados à ocorrência de hipertensão intracraniana em crianças e adolescentes vítimas de traumatismo cranioencefálico

Abstract

Objectives: The authors analyzed the correlation between the occurrence of intracranial hypertension (ICH) in children victims of traumatic brain injury (TBI) and age, punctuation on Glasgow Coma Scale (GCS) and on Pediatric Trauma Score (PTS), presence of abnormal postures, tomographic lesions, hemodynamic instability and associated lesions. The complications of intracranial pressure (ICP) monitoring werealso evaluated. Methods: Cohort study accomplished from September 1998 to August 2003. Were included children with age under 16 years old admitted in pediatric intensive care unit (ICU) of João XXIII Hospital with TBI and ICP monitoring. Were submitted the variables that showed p < 0.25 on multivariate analysis with logistic regression. Were considered significant those that had p < 0.05. Results: Were included 177 patients,between the ages of 2 months old and 16 years old, median of 9.7. The mean of punctuation on GCS and on PTS was 6.82 (± 2.79) and 4.42 (± 2.89), respectively. Pedestrian injury occurred in 60.3% of the cases. One hundred thirty four patients (75.7%) had ICH, and 77 (43.5%) had refractory ICH. Forty five patients were classified as having moderate or mild TBI when admitted (punctuation > 8 on GCS) and had ICPmonitoring because of tomographic disturbance or neurological deterioration. In this group, ICH and refractory ICH occurred in 68.9% and 44.4%, respectively. None of the studied factors was related to higher frequency of these events in this group. One hundred and thirty two patients had severe TBI (punctuation < 9 on GCS), with 80.3% of ICH and 43.2% of refractory ICH. Multivariate analysis showed that lower age was a factor related to higher occurrence of ICH in the group with severe TBI. The occurrence of refractory ICH was related to the presence of abnormal postures in patients with severe TBI. The analysis in linear regression of the relation between age and the occurrence of ICH showed that lower age is related to higher occurrence of ICH. There was 7.9% of infection on patients who had ICP monitoring and 4.6% on those withoutICP monitoring, without significant difference (p=0.292). There was no patient who needed surgical management for hemorrhage complications of ICP monitoring. Conclusions: The study concluded that ICH and refractory ICH were very frequent in children with severe TBI and with mild and moderate TBI followed by clinical deterioration; lower age in severe TBI increased the chances of developing ICH; the presence of abnormal postures in pediatric patients with severe TBI was related to higher occurrence of refractory ICH; and ICP monitoring complications in this group did not have clinical relevance. The discretions for ICP monitoring in pediatric patients should be different from those considered for adults.