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Abstract
RÉSUMÉ
Introduction. Le but de notre étude était d’étudier les facteurs pronostiques des traumatismes crânioencéphaliques (TCE) modérés et sévères de l’enfant en réanimation. Méthodologie. Il s’est agi d’une étude longitudinale, analytique et rétrospective. Étaient inclus, les dossiers des enfants des deux sexes hospitalisés dans les services de réanimation de deux hôpitaux de Yaoundé, pour TCE modéré à sévère du 31 Janvier 2012 au 31 Janvier 2017. Les données collectées étaient l’âge, le sexe, les circonstances du traumatisme, la cause du TCE, le mode de transport, la provenance, l’examen clinique, les examens complémentaires, la prise en charge, l’évolution, les complications et la mortalité. Les données ont été analysées à l’aide du logiciel Statistic package for social sciences (SPSS) 23. Les données catégorielles ont été comparées avec le test de Chi2 de Pearson ou le test de Fisher Exact. Les données continues ont été comparées à l’aide du test T de Student. Une valeur de p < 0,05 était considérée comme significative. Résultats. La taille de l’échantillon était de 56 patients. Le sex-ratio était de 1,8. Un TCE sévère a été retrouvé chez 58,9 %. Une tomodensitométrie cérébrale a été réalisée chez 49 enfants (87,5%). Les complications étaient représentées par les ACSOS (n=19) et les infections (n=13). Les séquelles neurologiques ont été retrouvées chez 13 patients (23,6%). Le taux de mortalité était de 38,2% (n=21). Les facteurs pronostiques étaient liés à la sévérité du traumatisme, le retard diagnostique, la survenue des complications. Conclusion. Les traumatismes crânioencéphaliques sont fréquents chez l’enfant. La mortalité est élevée en réanimation.
ABSTRACT
Background. The aim of our study was to study the outcome of moderate and severe pediatric traumatic brain injury (TBI) in intensive care unit (ICU). Methodology. This was a longitudinal, analytical and retrospective Methodology: This was a longitudinal, analytical and retrospective study. Were included, the files of children of both sexes hospitalized in the ICU of the two hospital of Yaoundé, for moderate and severe TBI from January 31, 2012 to January 31, 2017. The data collected were age, sex, circumstances of the trauma, cause, clinical examination, additional examinations, evolution, complications and mortality. Data were analyzed using the Statistic package for social sciences 23 (SPSS 23) software. Categorical data were compared with Pearson's Chi2 test or Fisher's Exact test. Continuous data were compared using Student's T test. A value of p <0.05 was considered significant. Results. The sample size was 56 patients. The sex ratio was 1.8. Severe TBI was found in 58.9%. Cerebral computed tomography was performed in 49 children (87.5%). Complications were represented by SBIOS (n = 19) and infections (n = 13). Neurological sequelae were found in 13 patients (23.6%). The mortality rate was 38.2% (n =21). The prognostic factors were related to the severity of the trauma, the diagnostic delay, the occurrence of complications. Conclusion. Traumatic brain injury are common in children. Mortality is high in ICU.
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References
- Felise S. Zollman. Manual of Traumatic Brain Injury. Second Edition. New York: Springer Publishing Company; 2016. 585 p.
- Sheriff F, Hinson H. Pathophysiology and Clinical Management of Moderate and Severe Traumatic Brain Injury in the ICU. Semin Neurol. 2015 Feb 25;35(1):042–9.
- Fondop. Prise en charge des traumatismes crâniens hospitalisés à l’Hôpital Central de Yaoundé [Mémoire de capacité de médecine d’urgence]. [Yaoundé]: Université de Yaoundé I; 2003.
- O’Lynnger TM, Shannon CN, Le TM, Greeno A, Chung D, Lamb FS, et al. Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge. J Neurosurg Pediatr. 2016 Jan;17(1):19–26.
- van Baalen B, Odding E, Maas AIR, Ribbers GM, Bergen MP, Stam HJ. Traumatic brain injury: classification of initial severity and determination of functional outcome. Disabil Rehabil. 2003 Jan 7;25(1):9–18.
- Lloyd J, Wilson ML, Tenovuo O, Saarijärvi S. Outcomes from mild and moderate traumatic brain injuries among children and adolescents: A systematic review of studies from 2008–2013. Brain Inj. 2015 Apr 16;29(5):539–49.
- Etienne Odimba. Aspects particuliers des traumatismes dans les pays peu nantis d’Afrique. Un vécu chirurgical de 20 ans. E-Mém Académie Natl Chir. 2007;6(2):44–56.
- National Institute of Neurological Disorders and Stroke. Traumatic Brain Injury, hope through research. Maryland: National Institutes of Health; 2015. 1-52 p.
- Alhelali I, Stewart TC, Foster J, Alharfi IM, Ranger A, Daoud H, et al. Basal skull fractures are associated with mortality in pediatric severe traumatic brain injury: J Trauma Acute Care Surg. 2015 Jun;78(6):1155–61.
- Guilliams K, Wainwright MS. Pathophysiology and Management of Moderate and Severe Traumatic Brain Injury in Children. J Child Neurol. 2016 Jan 1;31(1):35–45.
- Motah M, Sende Ngonde C, Beyiha G, Belley Priso E, Malongte Nguemgne C, Gonsu Fotsin J, et al. Prise en charge des traumatismes crâniens isolés à l’Hôpital Générale de Douala. Health Sci. 2011 Sep;12(3):1–6.
- Bigler ED, Abildskov TJ, Petrie J, Farrer TJ, Dennis M, Simic N, et al. Heterogeneity of brain lesions in pediatric traumatic brain injury. Neuropsychology. 2013;27(4):438–51.
- Vázquez-Solís MG, Villa-Manzano AI, Sánchez-Mosco DI, Vargas-Lares J de J, Plascencia-Fernández I. [Prognosis in pediatric traumatic brain injury. A dynamic cohort study]. Rev Medica Inst Mex Seguro Soc. 2013 Aug;51(4):372–7.
- Stewart TC, Alharfi IM, Fraser DD. The role of serious concomitant injuries in the treatment and outcome of pediatric severe traumatic brain injury: J Trauma Acute Care Surg. 2013 Oct;75(5):836–42.
- Mendy J, Kpelao E, Sakho Y, Gaye M, Ndoye N, Thiam AB, et al. Traumatismes crâniens graves de l’enfant : prise en charge et pronostic à court terme à Dakar. Rev Afr D’Anesthésiologie Médecine D’Urgence. 2014 Jan;19(1). (16)
- Nnadi MON, Bankole O, Fente B. Epidemiology and treatment outcome of head injury in children: A prospective study. J Pediatr Neurosci. 2014;9(3):237. (78)
- Kan CH, Saffari M, Khoo TH. Prognostic Factors of Severe Traumatic Brain Injury Outcome in Children Aged 2–16 Years at A Major Neurosurgical Referral Centre. Malays J Med Sci MJMS. 2009;16(4):25–33. (79)
- Udoh D, Adeyemo A. Traumatic brain injuries in children: A hospital-based study in Nigeria. Afr J Paediatr Surg. 2013;10:154. (80)
- Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2012 Jan;13 Suppl 1:S1-82. (81)
- Adekanmi A, Adeniji-Sofoluwe A, Obajimi M. Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review. Afr J Trauma. 2015;4(2):45.
- Kannan N, Ramaiah R, Vavilala MS. Pediatric Neurotrauma. Int J Crit Illn Inj Sci. 2014;4(2):131–7.
References
Felise S. Zollman. Manual of Traumatic Brain Injury. Second Edition. New York: Springer Publishing Company; 2016. 585 p.
Sheriff F, Hinson H. Pathophysiology and Clinical Management of Moderate and Severe Traumatic Brain Injury in the ICU. Semin Neurol. 2015 Feb 25;35(1):042–9.
Fondop. Prise en charge des traumatismes crâniens hospitalisés à l’Hôpital Central de Yaoundé [Mémoire de capacité de médecine d’urgence]. [Yaoundé]: Université de Yaoundé I; 2003.
O’Lynnger TM, Shannon CN, Le TM, Greeno A, Chung D, Lamb FS, et al. Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge. J Neurosurg Pediatr. 2016 Jan;17(1):19–26.
van Baalen B, Odding E, Maas AIR, Ribbers GM, Bergen MP, Stam HJ. Traumatic brain injury: classification of initial severity and determination of functional outcome. Disabil Rehabil. 2003 Jan 7;25(1):9–18.
Lloyd J, Wilson ML, Tenovuo O, Saarijärvi S. Outcomes from mild and moderate traumatic brain injuries among children and adolescents: A systematic review of studies from 2008–2013. Brain Inj. 2015 Apr 16;29(5):539–49.
Etienne Odimba. Aspects particuliers des traumatismes dans les pays peu nantis d’Afrique. Un vécu chirurgical de 20 ans. E-Mém Académie Natl Chir. 2007;6(2):44–56.
National Institute of Neurological Disorders and Stroke. Traumatic Brain Injury, hope through research. Maryland: National Institutes of Health; 2015. 1-52 p.
Alhelali I, Stewart TC, Foster J, Alharfi IM, Ranger A, Daoud H, et al. Basal skull fractures are associated with mortality in pediatric severe traumatic brain injury: J Trauma Acute Care Surg. 2015 Jun;78(6):1155–61.
Guilliams K, Wainwright MS. Pathophysiology and Management of Moderate and Severe Traumatic Brain Injury in Children. J Child Neurol. 2016 Jan 1;31(1):35–45.
Motah M, Sende Ngonde C, Beyiha G, Belley Priso E, Malongte Nguemgne C, Gonsu Fotsin J, et al. Prise en charge des traumatismes crâniens isolés à l’Hôpital Générale de Douala. Health Sci. 2011 Sep;12(3):1–6.
Bigler ED, Abildskov TJ, Petrie J, Farrer TJ, Dennis M, Simic N, et al. Heterogeneity of brain lesions in pediatric traumatic brain injury. Neuropsychology. 2013;27(4):438–51.
Vázquez-Solís MG, Villa-Manzano AI, Sánchez-Mosco DI, Vargas-Lares J de J, Plascencia-Fernández I. [Prognosis in pediatric traumatic brain injury. A dynamic cohort study]. Rev Medica Inst Mex Seguro Soc. 2013 Aug;51(4):372–7.
Stewart TC, Alharfi IM, Fraser DD. The role of serious concomitant injuries in the treatment and outcome of pediatric severe traumatic brain injury: J Trauma Acute Care Surg. 2013 Oct;75(5):836–42.
Mendy J, Kpelao E, Sakho Y, Gaye M, Ndoye N, Thiam AB, et al. Traumatismes crâniens graves de l’enfant : prise en charge et pronostic à court terme à Dakar. Rev Afr D’Anesthésiologie Médecine D’Urgence. 2014 Jan;19(1). (16)
Nnadi MON, Bankole O, Fente B. Epidemiology and treatment outcome of head injury in children: A prospective study. J Pediatr Neurosci. 2014;9(3):237. (78)
Kan CH, Saffari M, Khoo TH. Prognostic Factors of Severe Traumatic Brain Injury Outcome in Children Aged 2–16 Years at A Major Neurosurgical Referral Centre. Malays J Med Sci MJMS. 2009;16(4):25–33. (79)
Udoh D, Adeyemo A. Traumatic brain injuries in children: A hospital-based study in Nigeria. Afr J Paediatr Surg. 2013;10:154. (80)
Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2012 Jan;13 Suppl 1:S1-82. (81)
Adekanmi A, Adeniji-Sofoluwe A, Obajimi M. Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review. Afr J Trauma. 2015;4(2):45.
Kannan N, Ramaiah R, Vavilala MS. Pediatric Neurotrauma. Int J Crit Illn Inj Sci. 2014;4(2):131–7.