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Master Thesis

Facteurs pronostiques du devenir neurologique des enfants atteints de traumatisme crânien non accidentel (TCNA) : une étude rétrospective, multicentrique, de cohorte

Abstract : Infants with suspected or confirmed Abuse Head Trauma (AHT) are commonly admitted in Paediatric Intensive Care Units (PICUs) at early stage of the disease and AHT remains the leading cause of brain injury in infants. However, the neurological outcome of these patients is scarcely described.This study aims to describe a cohort of patients with AHT and to identify early risk factors associated with a poor neurological outcome.A multi-center retrospective study was conducted over a 8-years period (from January 2012 to December 2020). Children under one-year-old admitted in PICU with a certain or probable diagnosis of AHT were included. The neurological outcome was assessed by Paediatric Overall Performance Category score (POPC) at discharge from hospital and at 2 years.A total of 117 patients (mean age 4.3 (+/- 2.5) months, 61% boys) from 3 PICUs were included in our cohort. The average Glasgow score at admission was 11. Cerebral imagery found a subdural hematoma in 112 (96%), a tadpole sign in 80 (68%), a diffuse hypoxic brain injury in 45 (38%) and a cerebral atrophy in 32 (27%). Retinal haemorrhages were found in 92 (79%) patients. At 2 years follow up, 23 patients (20%) had multiple severe disabilities (20%). The main neurological sequelae were neurodevelopmental (n=38, 35%) or hyperactivity disorder (n=36, 33%), epilepsy (n=34, 31%) and motor deficit (n=28, 26%). A total of 40 patients (37%) suffered from ophthalmologic sequelae. After multivariate analysis, the factors associated with a poor neurological outcome on discharge from hospital were a cardio-respiratory arrest before or during stay, a low Glasgow score at admission, the presence of cerebral ischemia or atrophy on imaging and the need for invasive ventilation. After analysis according to the hierarchical model, only the presence of cardiorespiratory arrest and the low Glasgow score stand out as factors of poor outcome.This study highlights the wide range of sequelae in children with AHT and the importance of a multidisciplinary follow-up, especially in children with early risk factors of poor neurological outcome. Knowledge of the risk factors for a bad neurological outcome is essential to improve the initial care and follow-up of children who are victims of AHT. Given the importance and the variability of the sequelae, multidisciplinary follow-up is essential to detect neurocognitive difficulties as early as possible and to set up appropriate rehabilitation and social assistance at an early stage.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03297063
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Friday, July 23, 2021 - 10:18:26 AM
Last modification on : Sunday, July 25, 2021 - 3:26:01 AM
Long-term archiving on: : Sunday, October 24, 2021 - 6:14:03 PM

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  • HAL Id : dumas-03297063, version 1

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Fanny Regeffe. Facteurs pronostiques du devenir neurologique des enfants atteints de traumatisme crânien non accidentel (TCNA) : une étude rétrospective, multicentrique, de cohorte. Médecine humaine et pathologie. 2021. ⟨dumas-03297063⟩

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