Managementandoutcomeofsevereheadinjuries in theTrentregion 1985-90

AbstractIn a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7-8 years) were studied whohadsuffered a major headinjury (29 roadtraffic accidents, sixfalls, and four non-accidental injury). The injuryhad been assessed clinically and by cranialcomputed tomography or cranial ultrasound (in a single babyof 2 months). Initial Glasgow comascores forall subjectsrangedfrom 3-11 (mean 55), intact survivors 5-11 (7.4), minorhandicap 4-11(6-1), majorhandicap 3-6(4.3),fatalities 3-6 (4-1). All were treated withsedation, paralysis, hyperventilation (arterial carbon dioxide tension 3-0-3-5 kPa), intra- cranial pressure monitoring and moderatebody surface hypothermia to 32°C. Ninechildren died and 30 survived (nine intact, 13minor disability, and eight major disability).The worst cerebral perf4sion pressure wasover 40 mm Hg in all but one survivor, andless than40 mm Hgin seven ofninefatalities.Severe hypocapnia both in the first 24 hours and overali was correlatedwith