Low morbidity and mortality in children with severe traumatic brain injury treated according to the Lund concept: A population-based study.

Previous reports of mortality and morbidity in pediatric severe traumatic brain injury (TBI) vary considerably, with few population-based studies. Mortality rates from 3-33 % and varying morbidity have been reported, most commonly using the extended Glasgow outcome scale (eGOS). The Lund concept is a treatment algorithm for severe TBI aiming at controlling intracranial pressure (ICP) by reducing cerebral perfusion pressure (CPP). The aim of the present study was to retrospectively assess mortality and morbidity in a population of pediatric TBI treated with the Lund concept. All cases of pediatric TBI (<18 years) in the southern region of Sweden during 19 years were assessed. Patients were treated according to the Lund concept. Mortality, eGOS, ICP, CPP, time in NICU, drugs delivered and surgical procedures were recorded. Data were analysed both by dichotomised categories and by ordinal statistics. 136 cases of severe TBI < 18 years of age were recorded (incidence 2.0/100000) and 86 patients were admitted to the tertiary NICU. Mortality including all cases was 36% (incidence 0.7/100000) and in NICU 10%. Outcome was good in 60%, moderate in 25%, unfavourable in 15% with none in a vegetative status. In both dichotomized and ordinal analyses, CPP < 40 mmHg and ICP > 15 were associated with poor outcome, supporting current guidelines. However, high CPP was also associated with increased mortality and morbidity, supporting that elevated CPP might increase cerebral edema. The Lund concept resulted in low mortality and a favourable outcome in a majority of severe pediatric TBI patients.