Predictive value of scoring system in severe pediatric head injury

Dovilė Evalda Grinkevičiūtė, Rimantas Kėvalas, Viktoras Šaferis¹, Algimantas Matukevičius¹, Vytautas Ragaišis², Arimantas Tamašauskas¹

Department of Children’s Diseases, ¹Institute for Biomedical Research, ²Department of Neurosurgery, Kaunas University of Medicine, Lithuania

Key words: pediatric head trauma; Glasgow Coma Scale, Pediatric Trauma Score; Glasgow Outcome Scale, Pediatric Index of Mortality 2.

Summary. Objectives. To determine the threshold values of Pediatric Index of Mortality 2 (PIM 2) score, Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) score for mortality in children after severe head injury and to evaluate changes in outcomes of children after severe head injury on discharge and after 6 months.

Material and methods. All children with severe head injury admitted to the Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital, Lithuania, from January 2004 to June 2006 were prospectively included in the study. The severity of head injury was categorized according to the GCS score ≤8.

As initial assessment tools, the PTS, postresuscitation GCS, and PIM 2 scores were calculated for each patient. Outcome was assessed according to Glasgow Outcome Scale on discharge and after 6 months.

Results. The study population consisted of 59 children with severe head injury. The group consisted of 37 (62.7%) boys and 22(37.3%) girls; the mean age was 10.6±6.02.

The mean GCS, PTS, and PIM 2 scores were 5.9±1.8, 4.8±2.7, and 14.0±19.5, respectively. In terms of overall outcome, 46 (78.0%) patients survived and 13 (22.0%) died.

All three scales appeared to be significant predictors of death. Threshold values for which potential mortality in children after severe head injury increased were 10.75 for PIM 2, 3 for PTS and 5 for GCS. PIM 2 score provided the best discrimination between survivors and nonsurvivors.

Conclusions. The threshold values for mortality in children after severe head trauma were PIM 2≥10.75%, PTS≤3 and GCS≤5, and these values were significant risk factors of death in severely head injured children. The changes in outcome for survivals on discharge and after 6 months were statistically significant.

Correspondence to D. E. Grinkevičiūtė, Department of Children’s Diseases, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: dovilgrin@hotmail.com

Received 4 April 2007, accepted 13 November 2007