Mortality and Functional Outcome in Pediatric Trauma Patients with and without Head Injuries

OBJECTIVE: To determine the impact of traumatic head injury (THI) on pediatric patients in the U.S. using a national trauma database by assessing mortality rates and functional outcome at hospital discharge. METHODS: Data consisted of the National Pediatric Trauma Registry Phase III. Patients were categorized into those with or without head injuries based on ICD9 diagnosis codes. Death, functional outcome, extended care and ICU days were compared. Injury severity was assessed using the New Injury Severity Score (NISS), Relative Head Injury Severity Scale (RHISS) and GCS. Data were analyzed by the chi-square test, Mann-Whitney U Test and the T-Test. A p < 0.05 was considered significant. RESULTS: There were 15,005 patients with head injuries and 20,380 patients without head injury. There were 1047 deaths with an overall mortality rate of 6.0% in the head injury group compared to 0.7% in the non-head injury group (risk ratio 9.1, 95% CI 7.6-10.8). 86% of the deaths had a head injury. THI was listed as the primary cause of death in 74% of the non-survivors. The average NISS was also significantly increased in the head injury group (6.54 vs 15.33). The presence of head injury did not increase the chance a child might require ICU. However, those in the ICU with a head injury had a significantly longer stay there (1.85 days vs 0.47 days). Functional outcome at discharge was assessed in three fields; speech, feeding and walking. Speech and feeding difficulties were associated with increasingly severe head injury whereas walking was not. The number of patients discharged to extended care was also significantly increased in the head injury group (7.8% vs 1.8%). CONCLUSION: Head injury in a pediatric trauma patient significantly increases mortality, is associated with worse functional outcome at discharge and increased need for extended care. It is unlikely for a child to die of trauma without a THI. Therefore, prevention of head injury is of paramount importance in this age group.