Severe traumatic brain injury in pediatric patients:: treatment and outcome using an intracranial pressure targeted therapy -: the Lund concept

Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A two-center retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years ( range 3 months - 14.2 years), Glasgow Coma Scale 7 ( 3 - 8), and Injury Severity Score 25 ( 16 - 75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome ( Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up ( median 12 months postinjury, range 2.5 - 26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.