Objectives

1. State the significance and incidence of traumatic brain injury in children as well as the impact of preventive care.

2. Recognize when a child with a closed-head injury is developing increased intracranial hypertension.

3. Describe the pathophysiology of primary brain injury as well as the process leading to the secondary injury.

4. List therapies (as well as the rationale) for both the first-tier and second-tier therapies for the management of severe traumatic brain injury in children.

SUMMARY

Severe traumatic brain injury (TBI) is a leading cause of mortality and morbidity in children. The epidemiology, pathophysiology, and rational for various treatment modalities are presented in this chapter. In addition, clinical guidelines are reported in an algorithm format to aide the clinician caring for the critically ill children.

INTRODUCTION AND CLINICAL PRESENTATIONS

Although most TBIs in children are minor, head injury is the leading cause of pediatric death from trauma and it is the leading cause of acquired disability annually. By some accounts TBI results in 400,000 emergency department visits per year. Three to fifteen percent of cases result in moderate to severe TBI, and 9 to 50 percent of the most severe cases result in death. With current management approaches, mortality is only half that reported in adults presenting with similar Glasgow Coma Scores (GCS) [1–5]. Survival, however, has been associated with subsequent cognitive and behavioral impairment.

Prognosis and mechanisms of injury vary by age, type of activity, geographical location, and helmet use.