Title

Identification of hospital based factors associated with 30-days clinical outcomes in pediatric patients with head injury

Date of Award

2016

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Trauma is one of the leading causes of mortality and morbidity both in childhood and adult population. Children with traumatic brain injury (TBI) are at risk of death and permanent neurological disability. Children are especially vulnerable to TBI due to the softer pliable skull 1 and susceptibility to accelerating and decelerating forces. Infants present mainly after falls, while older children suffer from transportation accidents and sports-related injuries. In the absence of a clear mechanism of injury, the physician must also consider inflicted TBI. When faced with a head-injured child, rapid and accurate diagnosis may be hindered by the variable presentation of the pediatric patient. Early decisions for the need of brain imaging, immediate resuscitation, and prompt treatment of raised intracranial pressure (ICP) are pivotal for good outcomes in patient with head injury. Objective: To compare 30-day clinical outcome in pediatric patient with head injury among those having CT scan done early as compare to those who have delay in CT scan. Methodology: This is a prospective cohort study in which a cohort of pediatric patients with head injury was enrolled at the time of presentation to the emergency dep.artment of the hospital. Total of three major hospital of Karachi were included, Aga Khan Hospital (AKU), Jinnah Post Medical college hospital (JPMC) and Abbasi Shaheed Hospital (ASH). After enrollment, patients were divided into exposed (CT scan done after 2-hours) and unexposed groups (CT scan done within 2-hours) follow up was done till 30 days to assess their outcome. The follow-up time was calculated from the date of presentation to the hospital. Cox proportional hazard model of survival analysis was used to assess the significance of variables with the outcome. Results: A total of 157 patients were included, out of which ninety four (59.87%) were exposed having CT scan done after 2-hours while sixty three (40.1%) were unexposed having CT scan done within 2-hours. The mean age of child having event in exposed group was 7.3years (Cl, 2.43 12.22) while in exposed group was 7.0years (CI, 5.46 8.60). Male were predominant in both group with 62(65.9%) and 45(71.4%) in exposed and unexposed group respectively. Majority of cases in exposed group 61(64.8%) and unexposed group 35(55.5%) used non ambulance mode of transport to reached hospital. The mean Glasgow coma scale (GCS) in exposed group having event was 6.8 (CI 5.8, 7.7) and in unexposed group was 4 (CI 2.8, 5.1). After applying Cox Proportional Hazard model of survival analysis, final model shows two significant variables ,time from ER to CT scan (HR,11.43, CI, 1.51 86.26 ), and GCS (HR,059, CI, 0.51 0.69) with one interaction between main exposure and maintaining of circulation (HR, 0.04, CI, 0.003, 0.554). Conclusion: Though the sample is small, our study highlights the possible importance of early brain imaging. Apart from patient's arrival GCS that can predict the outcome , multiple other in-hospital factors were also identified through this study which plays important role in the outcome of patient that can be improved. Key words: Pediatric population, head injury, Hospital based factors.

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