Secondary systemic insults to the injured brain in children.

Objective: To assess incidence of secondary brain insults of systemic origin (SBISOs) such as arterial hypotension, hypoxaemia, hypercarbia, and anaemia in severely head injured children; to assess their impact on mortality and morbidity in the short-and long-term. Study design: Prospective, open study covering a 24-month period. Patients: Seventy-one children, under 15 years of age, admitted to a trauma centre for severe brain injury, Method: Analysis of SBISOs and outcome. Results: Twenty-five children were admitted with SBISOs. The mortality rate was 37%. After hospitalization, 84% of the children with SBISOs vs 46% without SBISOs had severe disability (Glasgow outcome score = 1, 2 and 3), After 1 year, 20 out of the 45 children still alive were contacted. One of the four with SBISOs communicated a bad recovery. Fifteen children without SBISOs presented good recovery: GOS = 4-5, paediatric overall performance category (POPC scale) = 1-2. Conclusion: Hypotension was associated with significant increase in mortality (x 3.6) in children with severe head injury. The consequences were worse when anaemia was associated. (C) 1998 Elsevier, Paris.