Abstract and Introduction
Abstract
The care of the pediatric patient with a severe traumatic brain injury (TBI) is an all-encompassing nursing challenge. Nursing vigilance is required to maintain a physiological balance that protects the injured brain. From the time a child and family first enter the hospital, they are met with the risk of potential death and an uncertain future. The family is subjected to an influx of complex medical and nursing terminology and interventions. Nurses need to understand the complexities of TBI and the modalities of treatment, as well as provide patients and families with support throughout all phases of care.
Introduction
Trauma remains the leading cause of preventable death in children. Traumatic brain injury (TBI) accounts for a large percentage of trauma-related deaths and complex morbidities. According to the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control 2010 report, an average of 1.7 million people annually suffer from TBI, accounting for 30% of all traumatic deaths. TBI remains the leading cause of death and disability in pediatric patients from birth to 19 years of age. Each year, 500,000 children are seen in Emergency Departments, and pediatric deaths from TBI are estimated to be 2,500, annually (CDC National Center for Injury Prevention and Control, 2010).
Traumatic brain injuries are predominate in two distinct pediatric age groups: toddlers and adolescents. Males of all ages have a higher incidence of TBI than females. Child abuse, specifically shaken baby syndrome, is the leading cause of TBI in children less than one year of age. Falls are the leading cause of nonfatal brain injury in the toddler age group. Falls from windows or objects, such as televisions falling onto the child's head, are also common factors in this age group (Gill & Kelly, 2013). Motor vehicle crashes, whether driver, passenger, or pedestrian, are the overwhelming cause of TBI in the adolescent age group (CDC National Center for Injury Pre vention and Control, 2010). Sports-related head injuries have been given a great deal of press in the past few years due in part to the recent studies of post-concussive injuries occurring at the professional level and in school-age children.
TBIs are categorized as mild, moderate, and severe. Children with mild brain injuries achieve a Glasgow Coma Scale (GCS) of 13 or higher. Moderate TBI is characterized by a loss of consciousness and physical and/or cognitive impairments with a GCS of 9 to 12. Children with severe TBI have GCS less than 8 and require airway and hemodynamic support (Tume, Thorburn, & Sinha, 2008).
Young children are more susceptible to head injury due in part to poor head control and a head size disproportioned to their body. The type of TBI that occurs in children is varied. Hematomas with or without skull fractures are common. Subdural hema tomas are venous in origin and may be acute or chronic in presentation. An epidural hematoma is usually arterial in origin and can develop rapidly, requiring early surgical intervention. Concussions are the result of a blow to the head or after rapid deceleration, as seen in motor-pedestrian events. Diffuse axonal in juries are characterized by loss of grey/white matter differentiation, with poor outcomes. Diffuse cerebral ede ma is most commonly seen in severe TBI.