Severe pediatric head injury: Myth, magic, and actual fact

Reports of low mortality rate for severely head-injured children have led to the myth that children have a better outcome than adults after severe head injury. This was examined in the present study by comparing the outcome of 4,041 severely head-injured children with 14,789 adults from five Level I trauma centers in the Pennsylvania Trauma Systems Foundation from 1986 to 1996. Severe head injury was defined as GCS <8, and outcome was defined by mortality. The overall mortality rate for children (<18 years) was 36.5% and for adults 47.6%. However, for patients involved in motor vehicle accidents, there was no clinically significant difference between children age 3-11 years (35%), age 12-18 years (31.4%) and adults (32.5%). The unprecedented low mortality rate for severe head injury in children was probably due to the selection bias of the patient population. We conclude that children involved in motor vehicle accidents are just as likely to die from severe head injury as adults.