RÉSUMÉ
Aim In response to the coronavirus 2019 disease (COVID-19) pandemic, governments worldwide implemented measures to prevent infection, resulting in restricted school activities, restricted children's freedom of movement, and increased risk of violence and injuries at home, including traumatic brain injury (TBI), among children. In Brazil, the consequences of the COVID-19 pandemic on the causes, severity, and mortality of pediatric TBI have not yet been investigated. Thus, our study aimed to determine whether the COVID-19 pandemic has affected the epidemiology of pediatric TBI among Brazilian children. Materials and methods We investigated the patients with TBI aged <18 years who visited a tertiary trauma center in Brazil in 2019 and 2020. TBI-related variables, such as classification, mechanism, clinical manifestations, need for intervention, morbidity, and mortality, were recorded. Furthermore, we used a nationwide databank to collect information on mortality from external causes of trauma and violence in the pediatric population in 2019 and 2020. The Mann-Whitney test was used to compare quantitative variables related to the mechanisms and severity of TBI in both periods in order to determine the impact of the COVID-19 pandemic. Results Of the patients with traumatic brain injury, 1371 visited the trauma center in 2019 and 1052 in 2020. No difference was noted in the incidence rate of abusive head trauma between these periods (p=0.142) or in mortality from violence in Brazil. Recreational causes of pediatric TBI increased during the first year of the COVID-19 pandemic in Brazil and falls from bicycles significantly increased during the pandemic (p<0.001). Conclusion A global reduction in pediatric admissions to emergency rooms as well as no impact on mortality and severity of pediatric TBI were observed during the COVID-19 pandemic in Brazil. Additionally, a public education program regarding child safety during recreational activities, particularly how to avoid falls from bicycles was recommended.
RÉSUMÉ
Objetivo: Analisar fatores associados à ocorrência de hipertensão intracraniana em pacientes pediátricos vítimas de traumatismo crânio-encefálico (TCE) grave. Métodos: Coorte com coleta retrospectiva do período de 1998 a 2003. Incluídos pacientes entre 0 e 16 anos com TCE, pontuação < 9 na escala de Glasgow e submetidos a monitoração da pressão intracraniana (PIC) (n = 132). A hipertensão intracraniana (HIC) foi definida como episódio de PIC > 20 mmHg com necessidade de tratamento e HIC refratária, acima de 25 mmHg, com necessidade de coma barbitúrico ou craniectomia descompressiva. Foi realizada análise univariada, seguida de multivariada, sendo consideradas significativas as variáveis com p < 0,05. Resultados: A idade variou entres 2 meses e 16 anos, mediana de 9,7 (6,0-2,3) anos. A pontuação de Glasgow foi de 3 a 8, mediana de 6 (4-7). O trânsito respondeu por 79,5 por cento dos eventos. A instalação do monitor ocorreu, em média, 14 h após o trauma, mediana de 24 h. Cento e três pacientes (78 por cento) apresentaram HIC, e 57 (43,2 por cento), HIC refratária. Na análise multivariada, a menor faixa etária foi associada a HIC risco relativo = 1,67 (1,03-2,72); p = 0,037, e a presença de posturas anormais foi associada a HIC refratária risco relativo = 2,25 (1,06-4,78). A mortalidade do grupo foi de 51,5 por cento e foi relacionada a uso de barbitúrico na HIC refratária e a baixa pressão de perfusão encefálica na unidade de terapia intensiva. Conclusões: HIC e HIC refratária foram eventos frequentes em pacientes pediátricos com TCE grave. Quanto menor a idade do paciente, maior a chance de desenvolvimento de HIC. A presença de posturas anormais foi fator associado a maior ocorrência de HIC refratária.
Objective: To analyze factors associated with intracranial hypertension in pediatric patients who suffered severe head injuries. Methods: Retrospective cohort study, with data collected from September 1998 through August 2003, including patients aged 0 to 16 who suffered severe head injuries, Glasgow score < 9, and submitted to intracranial pressure (ICP) monitoring (n = 132). Intracranial hypertension (IH) was defined as an episode of ICP > 20 mmHg requiring treatment, while refractory IH was ICP over 25 mmHg requiring barbiturates or decompressive craniectomy. Univariate analysis was followed by multivariate analysis; variables were considered significant if p < 0.05. Results: Ages ranged from 2 months to 16 years, median age 9.7 (6.0-2.3) years. Glasgow scores ranged from 3 to 8, median 6 (4-7). Traffic accidents were responsible for 79.5 percent of events. Monitoring devices were installed, on average, 14 hours after trauma, median time 24 hours. One hundred and three patients (78 percent) had IH, while 57 (43.2 percent) had refractory IH. In multivariate analysis, younger age ranges were associated with IH relative risk = 1.67 (1.03-2.72); p = 0.037, and abnormal postures were associated with refractory IH relative risk = 2.25 (1.06-4.78). The group mortality rate was 51.5 percent; it was correlated with use of barbiturates in refractory IH and low cerebral perfusion pressure at the intensive care unit. Conclusions: IH and refractory IH were frequent events in pediatric patients who suffered severe head injuries. The younger the patient, the greater the chance of developing IH. The presence of abnormal postures was found to be a risk factor for refractory IH.