J M López Álvarez

Publications (2)2.14 Total impact

• Article: [Severe pediatric head injuries (II): factors associated to morbidity-mortality].

  J M López Álvarez, M E Valerón Lemaur, O Pérez Quevedo, J M Limiñana Cañal, A Jiménez Bravo de Laguna, E Consuegra Llapurt, A Morón Saén de Casas, R González Jorge
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  ABSTRACT: To describe the factors associated to morbidity-mortality in pediatric patients with severe head injury (SHI). A review was made of the patients admitted to the Pediatric Intensive Care Unit (PICU) with SHI between July 1983 and December 2009. Of the 389 patients with head injuries, 174 (45%) presented SHI. The mean age of these subjects was 67 (9) months, with a Glasgow Coma Score (GCS) of 5.5 (1.8) and a PRISM score of 10.6 (6.7). Thirty-nine percent of the patients showed diffuse encephalic injury (DEI) in the computed tomography (CT) study. Seventy-nine percent of the patients subjected to intracranial pressure monitoring (ICP) presented intracranial hypertension. These patients had a greater incidence of serious sequelae (66.7 vs. 23.1%; p=0.01). Sequelae of clinical relevance were recorded in 59 patients (34%), and proved serious in 64% of the cases. The mortality rate among the patients with SHI was 24.7%, and mortality was significantly associated with a lower GCS score, hyperglycemia, intracranial hypertension and the presence of mydriasis or shock. The mortality rate associated to severe DEI was significantly higher than in the case of mild-moderate DEI (87.5 vs. 7.2%; p<0.001). The independent mortality risk factors in the pediatric patients with SHI were found to be the presence of mydriasis (OR: 31.27), intracranial hypertension (OR: 13.23) and hyperglycemia (OR: 3.10). a) SHI in pediatric patients was associated with high morbidity-mortality; b) intracranial hypertension was associated to the development of serious sequelae; c) independent mortality risk factors were the existence of mydriasis, intracranial hypertension and hyperglycemia.
  Medicina Intensiva 04/2011; 35(6):337-43. · 1.07 Impact Factor
• Article: [Severe pediatric head injuries (I). Epidemiology, clinical manifestations and course].

  J M López Álvarez, M E Valerón Lemaur, O Pérez Quevedo, J M Limiñana Cañal, A Jiménez Bravo de Laguna, E Consuegra Llapurt, A Morón Saén de Casas, R González Jorge
  [show abstract] [hide abstract]
  ABSTRACT: To describe the epidemiology, clinical manifestations and evolutive characteristics of pediatric patients with severe head injury (SHI). A review was made of the patients admitted to the pediatric intensive care unit (PICU) with SHI between July 1983 and December 2009. Of the 389 patients with head injuries admitted to the PICU during the study period, 174 (45%) presented SHI. The mean age in this group was of 67±9 months, with a Glasgow Coma Score (GCS) of 5.5±1.8 and a PRISM score of 10.7±6.7. The most frequent etiology of SHI was traffic accidents (56%), though these have decreased significantly in the last decade (58.5% vs 45.3%; P<.001). Twenty-one percent of the patients required evacuation of the lesions detected by computed tomography (CT), and 39% presented severe diffuse encephalic injury (DEI). Seventy-nine percent of the patients in whom intracranial pressure (ICP) was monitored presented intracranial hypertension. Sequelae of clinical relevance were recorded in 59 patients (39%), and proved serious in 64% of the cases. The mortality rate in this patient series was 24.7%. Intracranial hypertension decreased significantly in the last decade (88% vs 54%; P<.05), and clinical recovery has improved (23.3% vs 63.1%; P<.001). a) The incidence of traffic accidents has decreased in the last decade in the studied population; b) patients with SHI in which ICP was monitored showed a high incidence of intracranial hypertension; c) morbidity-mortality among pediatric patients with SHI has decreased over the course of the study period.
  Medicina Intensiva 04/2011; 35(6):331-6. · 1.07 Impact Factor