Defenestration in children younger than 6 years old: Mortality predictors in severe head trauma

Child s Nervous System (Impact Factor: 1.11). 09/2009; 25(9):1077-1083. DOI: 10.1007/s00381-009-0924-5


PurposeThis study aims to describe the characteristics of severe head injuries in children less than 6years old, victims of falls
from windows, and identify the main predictive factors of mortality in this population.

Patients and methodsA cross-sectional study was designed through data derived from medical records of less than 6-year-old children victims of
falls from windows presenting with a severe head injury defined by an initial Glasgow coma scale (GCS) ≤8, hospitalized at
a Pediatric Trauma center level III, between January 2000 and December 2005. Statistical analysis used univariate analysis
and multiple logistic regressions.

ResultsWe identified 58 severe head injuries in children victims of falls from windows. The mean age was 2.8 ± 1.4years, with a
male prevalence (64%); 48% of patients had a GCS ≤5; 62.1% had a Pediatric Trauma Score (PTS) ≤3 at hospital admission. The
mortality rate was 41% (24/58) and most of them (88%; 21/24) died within 48h. An increased death rate was noted in children
admitted with hypoxemia (p = 0.001), low systolic blood pressure (p = 0.002), hypothermia (p = 0.0001), GCS ≤5 (p = 10−5), PTS ≤3 (p = 0.008), hyperglycemia (p = 0.023), coagulation disorders (p = 0.02), and initial intracranial pressure ≥20mmHg (p = 0.03). Initial hypothermia, hyperglycemia, and coagulation disorders were the only independent predictive factors of mortality.

ConclusionSevere head injuries resulting from falls from windows carry a high risk of mortality in less than 6-year-old children. Hypothermia,
hyperglycemia, and coagulation’s disorders are independent predictive factors of mortality. Early deaths could be considered
as direct consequences of uncontrollable brain lesions.

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Available from: Jose Roberto Tude Melo
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