Pune : Doctors at Manipal Hospitals Momstory successfully managed two young brothers who sustained separate life-threatening injuries in a road traffic accident. The elder, aged six years and two months, suffered a severe traumatic brain injury with diffuse axonal injury and presented with a Glasgow Coma Scale (GCS) score of 7. His five-year-old younger brother sustained extensive abdominal trauma involving the liver, spleen and kidney and arrived at the hospital in shock with significant blood loss. Both children required immediate resuscitation, specialised paediatric intensive care and close multidisciplinary monitoring.
The children were travelling on a two-wheeler with their grandfather when the accident occurred. Their grandfather unfortunately succumbed to his injuries at the accident site. The two children were brought to the hospital soon after the accident, allowing the medical teams to begin emergency assessment and treatment without delay.
The elder brother was found to have a depressed fracture in the left frontoparietal region of the skull, brain contusion and severe diffuse axonal injury (DAI). DAI occurs when the sudden force of a traumatic injury causes widespread damage to the connections between nerve cells in the brain and is associated with prolonged unconsciousness and severe neurological impairment. With a GCS of 7 on arrival, the child required immediate neurocritical care and close monitoring in the Paediatric Intensive Care Unit (PICU).
Speaking about the case, Dr. Ganesh Badge, Paediatric Intensivist & PICU In-charge, Manipal Hospitals Momstory, said, “The elder child had sustained a severe brain injury and was poorly conscious when he arrived. Our immediate priority was to protect the brain from further injury by maintaining adequate oxygenation and blood pressure, providing appropriate ventilatory support, preventing seizures, maintaining fluid and electrolyte balance and closely monitoring his neurological status. The first two weeks were particularly challenging because neurological recovery was initially very slow.”
During his PICU stay, the child developed cerebral salt wasting, a condition in which the kidneys lose excessive amounts of sodium and fluid following certain brain injuries. This required frequent monitoring of sodium levels and fluid balance, with appropriate replacement and adjustment of treatment. He also received nutritional support and intensive neuro-physiotherapy as part of his recovery.
The turning point came during the third week, when the child began showing more purposeful movements and became progressively more responsive. He started recognising family members and his speech gradually improved. With continued neurocritical care, rehabilitation and multidisciplinary support, he made significant neurological recovery and was discharged home after approximately four weeks of hospitalisation.
While the elder brother was undergoing treatment for his brain injury, the younger brother was being treated for significant abdominal trauma. He presented in shock with pallor and evidence of substantial blood loss. Investigations revealed hemoperitoneum, or blood accumulation within the abdominal cavity, along with a Grade III liver injury, Grade IV splenic injury and injury involving the kidney, with blood also noted in the urine.
The child was immediately resuscitated with intravenous fluids, blood and blood products and circulatory support. The paediatric surgery team assessed him closely to determine whether emergency surgery would be required. Following resuscitation, his circulation stabilised and there was no evidence of uncontrolled ongoing bleeding. The team therefore opted for conservative management under continuous PICU monitoring.
Dr. Jayesh Desale, Paediatric Surgeon, Manipal Hospitals Momstory, said, “The younger child had significant injuries to multiple abdominal organs and initially presented in shock. After rapid resuscitation, his circulation stabilised and there were no clinical indications of uncontrolled ongoing bleeding requiring surgery. In appropriately selected children with solid-organ injuries, non-operative management can allow the injured organs to heal while avoiding the additional risks associated with surgery. In this case, close monitoring and timely intervention helped us continue treatment safely without an operation.”
The child’s clinical condition steadily improved, with his blood investigations and other parameters returning towards normal. He remained under close observation for any evidence of recurrent bleeding or deterioration and was discharged in a stable and healthy condition after approximately one week.
The two cases highlight the varied and potentially serious consequences of road traffic injuries in children. While the two brothers were involved in the same accident, they sustained very different injuries and required different treatment approaches. Early assessment, rapid stabilisation, appropriate imaging and continuous paediatric intensive care were critical to their recovery.
The children were managed by Dr. Ganesh Badge, Paediatric Intensivist & PICU In-charge; Dr. Sandeep Patil, Paediatric Neurologist; Dr. Vishal Rokade, Neurosurgeon; and Dr. Jayesh Desale, Paediatric Surgeon, with support from Dr. Meenakshi, Dr. Harshali, Dr. Swapnil, Dr. Furkan and Dr. Nikhil, along with the nursing, rehabilitation and PICU teams.
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