TRAUMA CRANEOENCEFÁLICO: FACTORES DE RIESGO DE MORTALIDAD EN PACIENTES DE 2 A 15 AÑOS ::: TRAUMATIC HEAD INJURY: RISK FACTORS OF MORTALITY IN 2 TO 15 YEARS OLD PATIENTS

Omar Naveda Romero, Andrea Naveda Meléndez

Resumen


El trauma craneoencefálico presenta una incidencia elevada y continúa siendo una de las principales causas de muerte y discapacidades permanentes en niños. Para identificar factores de riesgo de mortalidad en niños entre 2 y 15 años de edad con traumatismo craneoencefálico, se realizó un estudio observacional, analítico, prospectivo, donde se incluyeron 204 pacientes con trauma craneoencefálico con Escala de Coma Glasgow (GCS) menor de 13 puntos, divididos según la supervivencia. La mortalidad fue del 17,2%. En el análisis univariable, las características asociadas a mortalidad fueron: GCS < 9 puntos, PRISM (Pediatric Risk of Mortality) > 20 puntos, PTS (Pediatric Trauma Score) < 4 puntos, shock, coagulopatía, hipotermia, hipercapnia, anemia, hemorragia subaracnoidea, edema cerebral, lesión de tallo cerebral y diabetes insípida. Mediante regresión logística binaria se identificó como factores de riesgo para mortalidad por trauma craneoencefálico en niños: PRISM > 20 puntos (OR = 4,1; 95% IC: 1,9 - 14,3; p = 0,049), PTS < 4 puntos (OR = 3,9; 95% IC: 2,3- 18,1; p = 0,015), shock (OR = 5,0; 95% IC: 2,3 - 22,4; p = 0,035), coagulopatía (OR = 3,2; 95% IC: 2,1- 16,7; p = 0,016) y congestión vascular cerebral (OR = 4,2; 95% IC: 2,1 - 15,7; p = 0,029). El PRISM y el PTS son herramientas fiables para predecir mortalidad en niños con trauma craneoencefálico. El shock, la coagulopatía y el edema cerebral son lesiones secundarias que deben ser prevenidas y tratadas para mejorar la sobrevida en este grupo de pacientes.

 

Palabras clave: PRIMS, escala de trauma pediátrico, coagulopatía, congestión vascular cerebral.

 

ABSTRACT

 

Traumatic head injury has a high incidence and continues being a major cause of death and permanent disabilities in children. To identify risk factors for mortality in children between 2 and 15 years of age with traumatic brain injury, , an observational, analytical, prospective study was conducted , which enrolled 204 patients with GCS (Glasgow Coma Scale) under 13 points, divided according to survival. Mortality was 17.2%. In univariate analysis, the characteristics associated with mortality were: GCS < 9 points, PRISM (Pediatric Risk of Mortality) > 20 points, PTS (Pediatric Trauma Score) < 4 points, shock, coagulopathy, hypothermia, hypercapnia, anemia, subarachnoid hemorrhage, cerebral swelling, brain stem injury and diabetes insipidus. Through binary logistic regression, the risk factors of mortality for traumatic head injury in children were identified as: PRISM > 20 (OR = 4.1; CI 95%: 1.9 - 14.3; p = 0.049), PTS < 4 points (OR = 3.9; CI 95%: 2.3 - 18.1; p = 0.015), shock (OR = 5.0; CI 95%: 2.3 - 22.4; p = 0.035), coagulopathy (OR = 3.2; CI 95%: 2.1 - 16.7; p = 0.016) and cerebral swelling (OR = 4.2; CI 95%: 2.1 - 15.7; p = 0.029). PRISM and PTS are reliable tools to predict mortality in children with traumatic brain injury. Coagulopathy, shock and cerebral swelling are secondary lesions that must be prevented and treated to improve survival in this group of patients.

 

Key words: PRISM, pediatric trauma score, coagulopathy, cerebral swelling.


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