| Sažetak | Cilj istraživanja: Cilj ovog istraživanja bio je odrediti ishod u djece nakon traumatske ozljede mozga te istražiti utjecaj dobi, spola, vrste ozljede mozga, postojanja pridruženih ozljeda, načina ozljeđivanja, strojne ventilacije, duljine hospitalizacije i vrijednosti GCS na ishod.
Materijal i metode: Istraživanje je provedeno u Zavodu za intenzivnu pedijatriju s postintenzivnom skrbi, Klinike za dječje bolesti, KBC-a u Splitu retrospektivnom analizom medicinske dokumentacije u vremenskom razdoblju od 1. siječnja 2007. do 31. prosinca 2016. U istraživanje je uključeno 201 dijete, u dobi od jednog mjeseca do 18 godina, liječeno zbog traumatske ozljede mozga. Iz studije su isključeni ispitanici čiji su podaci bili nepotpuni (n=6). Svakom ispitaniku analizirane su sljedeće karakteristike: kronološka dob u mjesecima, spol, vrsta ozljede mozga, pridružene ozljede, način ozljeđivanja, Glasgow Coma Score (GCS), potreba za strojnom ventilacijom i dani strojne ventilacije, dani hospitalizacije, potreba za operacijskim zahvatom te ishod. Prilikom istraživanja proučavan je utjecaj pojedinih varijabli na ishod. Statistička analiza podataka provedena je uz pomoć statističkog programa SPSS (IBM SPSS Statistics, v.20), a razina statističke značajnosti postavljena je na α<0,05
Rezultati: U istraživanje je uključeno 195 ispitanika, 129 (66,2 %) muške i 66 (33,8 %) ženske djece. Sveukupna smrtnost djece nakon traumatske ozljede mozga iznosi 5,6 %. Smrtnost u odnosu na spol ne razlikuje se statistički značajno. Postoji statistički značajna razlika medijana dobi djece sa smrtnim ishodom (175 mjeseci) u odnosu na preživjele (119,5 mjeseci). Izoliranu ozljedu glave imala su 102 bolesnika (52,3 %), a ozljedu glave uz pridružene ozljede 93 bolesnika (47,7 %). Statistički značajno više djece koja su uz ozljedu glave imala i pridružene ozljede je umrlo (90,9 %), a najčešće su ozljede pluća i jetre, donjih ekstremiteta i zdjelice. Pad je bio najčešći način ozljeđivanja (39 %), ali niti jedno dijete nije umrlo. Najveći broj smrtnih ishoda zabilježeno je u djece pješaka (36,4 %), te putnika u automobilu i na motociklu (27,3 %). Većina bolesnika je strojno ventilirana ( 60,5 %), uključujući svu djecu sa smrtnim ishodom. Medijan trajanja strojne ventilacije statistički je značajno veči u umrle djece. Operacijski zahvat bio je potreban kod 26,2 % bolesnika, no nije statistički značajno utjecao na ishod. Također nije bilo statistički značajne razlike u ishodu i danima trajanje hospitalizacije. Najčešći su tip ozljede mozga intrakranijalna krvarenja (44,1 %). Statistički značajno više je djece umrlo zbog edema mozga ( 90,9 %) u odnosu na ostale vrste ozljede. Težina traumatske ozljede mozga, procijenjena prema Glasgovskoj ljestvici kome u 44,1 % bolesnika bila je teška. Statistički značajno niže vrijednosti GCS bile su u umrle djece, s medijanom od 3,0.
Zaključak: Više čimbenika može utjecati na ishod traumatske ozljede mozga u djece. Iz rezultata našeg rada vidi se da ishod ovisi o dobi, vrsti i težini ozljede mozga, pridruženim ozljedama, načinu ozljeđivanja te potrebi za strojnom ventilacijom. S obzirom da je traumatska ozljeda mozga jedan od najčešćih uzroka smrtnosti i pobola među djecom i adolescentima u razvijenim zemljama, potrebno je djelovati na sprječavanju ozljeda kao i mogućih teških posljedica. |
| Sažetak (engleski) | Objectives: The aim of this study was to determine the outcome of traumatic brain injury in children and to investigate the effects of age, sex, type of brain injury, associated injuries, the mode of injury, mechanical ventilation, length of hospitalization and GCS values on the outcome.
Material and Methods: The research was conducted in Pediatric intensive care unit (PICU), University hospital in Split, by a retrospective analysis of medical documentation between January 1st, 2007 and December 31st, 2016. The study included 201 children, age ranging from one month to 18 years, treated for traumatic brain injury. Children with the incomplete documentation (n = 6) were excluded from the study. The following characteristics were analyzed for each patient: chronological age in months, gender, type of brain injury, associated injuries, mode of injury, Glasgow Coma Score (GCS), the need for mechanical ventilation and days of mechanical ventilation, lenght of hospitalization, need for surgical intervention and outcome. The effect of individual variables on the outcome was studied during the research. The statistical analysis of the data was carried out using the SPSS statistical program (IBM SPSS Statistics, v.20), and the statistical significance level was set at α <0.05
Results: This study included 195 children, 129 (66.2 %) male and 66 (33.8 %) female. The overall mortality of children after traumatic brain injury was 5.6 %. Statistically, gender did not effect the mortality. There was a statistically significant difference between the median age of children with death outcome (175 months) compared to survivors (119.5 months). 102 patients (52.3 %) had isolated head injury and 93 patients (47.7 %) had head injury with associated injuries. The statistically significant number of children who had head injuries and associated injuries died (90.9%) and the most common injuries were the ones of lung and liver, lower extremities, and pelvic floor. The fall was the most common mode of injury (39 %), but none of the children died. The highest number of deaths was recorded in pedestrians (36.4 %) and in car and motorcycle passengers (27.3 %). The majority of patients were mechanically ventilated (60.5 %), including all children who died. The median duration of mechanical ventilation was statistically significant longer in children who died. A surgical intervention was needed in 26.2 % patients but did not affect the outcome. There were not any statistically significant differences in outcome and lenght of hospitalization. The most common type of brain injury was intracranial bleeding (44.1 %). Statistically, the largest number of children died due to the brain edema (90.9 %). The traumatic brain injury, estimated by Glasgow Coma Scale, was severe in 44.1 % children. Statistically significant lower GCS was recorded in children who died, with a median of 3.0.
Conclusion: Multiple factors can affect the outcome of traumatic brain injury in children. The results of our study show that the outcome depends on the age of children, type and severity of the brain injury, associated injuries, mode of injury and the need for mechanical ventilation. Since, traumatic brain injury is one of the most common causes of mortality and morbitity among children and adolescents in developed countries, it is necessary to act on preventing injuries as well as possible serious consequences. |
