Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 51, Num. 3, 2003, pp. 427

Neurology India, Vol. 51, No. 3, July, 2003, pp. 427

Prognosis in children with head injury: Inaccuracies in the analysis

Kumar S
Neurology Unit, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamilnadu - 632004

Correspondence Address:
Neurology Unit, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamilnadu - 632004
sk@cmcvellore.ac.in

Code Number: ni03147

Sir,
I read with great interest the recent article by Suresh et al.[1] They have highlighted some important predictors of poor outcome in children with head injury. Though the study findings are interesting, I would like to make certain comments.

Firstly, there are some factual errors pertaining to the figures. They are as follows:

1. Total number of children in the study: The abstract indicates a total of 340 children, but [Table:2] (heading) puts the figure as 329 (N=329).
2. Number of patients in age group 11-15 years: According to the abstract, there were 156 children, whereas there were only 135 children according to [Table:2] (we also get a third figure of 136 for the same age group by adding 115 and 21 children with good and poor outcomes respectively from the same table).
3. Number of patients in the GCS 3-5 group: According to the abstract, it is 40, whereas [Table:2] and the text (results section) show 41 children in the same age group.
4. Number of patients in the GCS 6-8 group: There were 55 children in this group according to the abstract, whereas [Table:2] and text (results section) show only 51 children in this group.
5. Total number of children with poor outcome: According to the last sentence of the article, 15.8% of all children (54 children) had poor outcome, whereas [Table:2] gives varying figures under different subheadings. GCS group shows 55 children (24+18+11+2) with poor outcome and associated pathologies group shows 58 children (3+8+10+25+12) with poor outcome.
6. Number of patients with contusion: According to the abstract, 85 patients had contusion, whereas [Table:2] and the text (results section) show only 55 patients with contusion. Percentages of patients with contusions who had poor outcomes are also slightly different in the abstract and text (18.8% and 18.2% respectively).

There are some other points that I would like to make:
1. Children in less than two years age group are too small in number to merit a comparison with other age groups. P value mentioned in [Table:2] is 0.74. Therefore, it should not have been included in the abstract (results section) as a feature associated with poor outcome.
2. [Table:2] shows the number of patients with various pathologies (fracture, EDH, contusion, diffuse injury and acute SDH). We are made to believe that each patient had only one pathology as total number adds up to 340 (the actual number of patients included in the study). It has been shown previously that many children with skull fracture have associated intracranial lesions (such as parenchymal injury, EDH, SDH, SAH and cerebral edema) on CT scan.[2]
3. Authors have not studied several other factors associated with poor outcome in children with head injury. Some of them include the presence of hypoxia, hypotension, hyperglycemia, disseminated intravascular coagulation and early post-traumatic seizures. [3]
In conclusion, though this study has provided interesting data regarding prognostic factors in children with head injury, there are several inaccuracies as pointed and some important prognostic factors have not been considered.

REFERENCES

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