Objective: To determine the outcome of seriously head-injured children and to analyse the factors that affect their prognosis.
Design: A retrospective analysis of all severely head-injured children treated between 1990 and 1993.
Setting: Red Cross War Memorial Children's Hospital's trauma unit and neurosurgery service.
Patients: One hundred and two children under the age of 14 years with admission Glasgow Coma Scores (GCSs) of below 8.
Results: There were 57 boys and 45 girls. The average time of assessment after injury was 2.8 hours. Eighty-three injuries were caused by pedestrian motor vehicle accidents. Thirty-seven were associated with other serious organ system injuries. Fifty-eight children died and only 36 made a good recovery. All children with a GCS of 3-4 died. Factors that were particularly associated with a poor prognosis were: (i) age less than 3 years; (ii) associated extracranial injury; (iii) GCS 3-4 following resuscitation; and (iv) diffuse cerebral swelling on computed tomography.
Conclusion: Pedestrian motor vehicle accidents are the most common cause of serious paediatric head injury in the Cape Town area. Children with a presenting coma score of less than 8 have an extremely high mortality and morbidity rate, despite modern intensive care. Preventive strategies are essential.