Management des Schädel-Hirn-Traumas im Kindesalter

Lehner, M.; Deininger, S. und Wendling-Keim, D. (2019): Management des Schädel-Hirn-Traumas im Kindesalter. In: Monatsschrift Kinderheilkunde, Bd. 167, Nr. 11: S. 994-1008

Abstract

Accidents are the leading cause of hospitalization in childhood and adolescence. Approximately 90% of fatal accidents in childhood are associated with traumatic brain injury (TBI). The classification is based on the Glasgow coma scale (GCS) adapted to children and is divided into three grades, mild, moderate and severe. The treatment of moderate and severe TBI must already start in the preclinical setting to avoid hypotension and hypoxia, as these two parameters significantly influence the outcome. In these patients, admission to a level 1 trauma center for children should be carried out by the emergency physician. 85% of patients are diagnosed as having mild TBI. Nevertheless, in this group clinically important intracranial injuries requiring surgery can also occur. It is generally necessary to diagnose the injuries of these patients within an observational period of 48 h. In childhood, inpatientmonitoring should be carried out before (primary) cranial computed tomography (CT) imaging to avoid unnecessary exposure to radiation and most probably an inconspicuous cranial CT scan. Meanwhile, well-validated algorithms have been published (PECARN rules), according to which the indications for cranial slice imaging investigations are oriented. In cases of severe TBI, in addition to a targeted and rapid patient treatment in the trauma room including neuroradiological diagnostics, monitoring of children is predominantly carried out in the intensive care unit. Children are prone to develop posttraumatic cerebral edema, which first requires medication treatment. The current recommendations of the Brain Trauma Foundation for treatment are discussed.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0026-9298
• Sprache: Deutsch