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Gunther OE, Garneau M, Geoffroy MC, Martin-Storey A, Latimer E, Déry M, Temcheff CE. Comparison of concordance and predictive validity of head injuries from parental reports and medical records. Brain Inj 2024:1-7. [PMID: 39041545 DOI: 10.1080/02699052.2024.2381046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD). DESIGN AND SETTING Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database. PARTICIPANTS Children (N = 685) ages 6-9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury. MAIN MEASURES Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers. RESULTS Results indicated poor agreement between the two forms of reporting κ = .161 (95% CI, .083 to .239), p < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury.
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Affiliation(s)
- Olivia E Gunther
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Mathilde Garneau
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Alexa Martin-Storey
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Eric Latimer
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Michèle Déry
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Caroline E Temcheff
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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2
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McCormick BF, Glenn AL. Youth with Low Pre-injury Mental Health Symptoms Are at a Higher Risk for Symptoms Following Mild Traumatic Brain Injury. Child Psychiatry Hum Dev 2024; 55:488-496. [PMID: 36066656 DOI: 10.1007/s10578-022-01433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Abstract
Mild traumatic brain injury (mTBI) is a growing public health concern, and it is a common injury amongst children and adolescents. Existing evidence suggests that mTBI in youth may be related to both externalizing and internalizing symptoms. However, many existing studies fail to control for pre-injury symptoms or consider the potential interaction between mTBI and pre-injury symptom levels. The current study employed data from a longitudinal sample (N = 1,803) of youth from the Project on Human Development in Chicago Neighborhoods to assess the interaction between pre-injury externalizing and internalizing symptoms and outcomes following mTBI in youth. The results showed, contrary to our expectations, that participants with lower pre-injury symptoms were at a greater risk for increased psychopathology following mTBI, compared to participants with higher pre-injury symptoms and non-injured participants. Potential explanations for the results and implications are discussed.
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Affiliation(s)
- Brandon F McCormick
- Department of Psychology, Center for Youth Development and Intervention, The University of Alabama, 348 Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA.
| | - Andrea L Glenn
- Department of Psychology, Center for Youth Development and Intervention, The University of Alabama, 348 Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA
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Carr HR, Hall JE, Brandt VC. Adolescent delinquency following co-occurring childhood head injuries and conduct problem symptoms: findings from a UK longitudinal birth cohort. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02335-0. [PMID: 38153523 DOI: 10.1007/s00787-023-02335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
Childhood conduct problems and head injuries share a bidirectional association, but how this affects the risk of adolescent delinquency is unknown. Due to their similar underlying mechanisms (i.e. increased impulsivity), this study aims to identify whether their co-occurrence increases the risk of adolescent delinquency. Data was obtained from 11,272 children at age 14 and 10,244 at age 17 years enrolled in the UK Millennium Cohort Study. Conduct problem symptoms (via the Strengths and Difficulties Questionnaire) and head injuries were parent reported from ages 3 to 14 years. Delinquency was self-reported at ages 14 and 17 including substance use, criminality, and antisocial behaviour. Incident rate ratios (IRR) were estimated for delinquency at ages 14 and 17 by childhood conduct problem and head injury status. Co-occurring head injuries and high conduct problem symptoms presented the greatest risk for overall delinquency and substance use at age 14 compared to those with the presence of one or neither (IRRs from 1.20 to 1.60). At age 17, conduct problems (with or without co-occurring head injuries) presented the greatest risk for overall delinquency, substance use, and antisocial behaviour. There was no evidence for an increased risk of delinquency at ages 14 or 17 following a head injury only. Whilst these findings suggest childhood head injuries alone do not increase the risk of adolescent delinquency, when co-occurring alongside high conduct problem symptoms there is a heightened earlier risk. These results provide further insight into adolescent delinquency and the outcomes of co-occurring childhood head injury and conduct problem symptoms.
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Affiliation(s)
- Hannah R Carr
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, University Road, Highfield Campus, Building 44, Southampton, SO17 1PS, UK.
| | - James E Hall
- Southampton Education School, University of Southampton, Southampton, UK
| | - Valerie C Brandt
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, University Road, Highfield Campus, Building 44, Southampton, SO17 1PS, UK
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Challakere Ramaswamy VM, Butler T, Ton B, Wilhelm K, Mitchell PB, Knight L, Greenberg D, Ellis A, Allnutt S, Jones J, Gebski V, Carr V, Scott RJ, Schofield PW. Self-reported traumatic brain injury in a sample of impulsive violent offenders: neuropsychiatric correlates and possible "dose effects". Front Psychol 2023; 14:1243655. [PMID: 37780150 PMCID: PMC10540069 DOI: 10.3389/fpsyg.2023.1243655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background Traumatic brain injury (TBI) is a major public health problem that may be associated with numerous behavioral problems, including impulsivity, aggression and violence. Rates of self-reported TBI are high within offender populations, but the extent to which TBI is causally implicated in causing illegal behavior is unclear. This study examined the psychological and functional correlates of histories of traumatic brain injury in a sample of impulsive violent offenders. Methods Study participants, all men, had been recruited to participate in a randomized controlled trial of sertraline to reduce recidivism. Study entry criteria were an age of at least 18 years, a documented history of two or more violent offenses and a score of 70 or above on the Barratt Impulsiveness Scale. An extensive list of standardized questionnaires was administered to obtain information on previous TBI and other neuropsychiatric conditions or symptoms. Results In the sample of 693 men, 66% were aged between 18 and 35 years old, and 55% gave a history of TBI ("TBI+"). Overall, 55% of study participants reported at least one TBI. High levels of neuropsychiatric symptomatology were reported. In 75% of TBI+ individuals, their most severe TBI (by self-report) was associated with loss of consciousness (LOC) < 30 min. Compared to TBI- (those without history of TBI) participants, TBI+ individuals were more impulsive (Eysenck Impulsivity), irritable, angry, and reported higher levels of assaultive behavior, depressive symptomology, alcohol use disorder, suicidal ideation, suicide attempts, and lower quality of life. Potential "dose effects" of TBI severity and frequency in terms of neuropsychiatric symptomatology were identified. Conclusion Like other studies of offender populations, single and multiple TBIs were very common. The associations of TBI, TBI severity, and TBI frequency (i.e., TBI "burden") with adverse neuropsychiatric phenomena suggest TBI contributes importantly to offender morbidity but the select nature of the sample and cross-sectional study design constrain the interpretation of these findings.
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Affiliation(s)
| | - Tony Butler
- University of New South Wales, Sydney, NSW, Australia
| | - Bianca Ton
- University of New South Wales, Sydney, NSW, Australia
| | - Kay Wilhelm
- University of New South Wales, Sydney, NSW, Australia
| | | | - Lee Knight
- University of New South Wales, Sydney, NSW, Australia
| | - David Greenberg
- University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Andrew Ellis
- University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | | | - Jocelyn Jones
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Vaughan Carr
- University of New South Wales, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Rodney J. Scott
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Peter William Schofield
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Neuropsychiatry Service, Hunter New England Mental Health, Newcastle, NSW, Australia
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Maresca G, Lo Buono V, Anselmo A, Cardile D, Formica C, Latella D, Quartarone A, Corallo F. Traumatic Brain Injury and Related Antisocial Behavioral Outcomes: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1377. [PMID: 37629667 PMCID: PMC10456231 DOI: 10.3390/medicina59081377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Higher level of aggression and antisocial behavior have been found in the period following head trauma. These changes are attributable to specific brain alterations that generally involved frontal lobe, insula and limbic system. A descriptive review was conducted on the specificity of aggressive behavior in relation to traumatic brain injury by evaluating numerous variables, focusing on age at the time of trauma and neuroimaging studies. Materials and Methods: We searched on PubMed and the Web of Science databases to screen references of included studies and review articles for additional citations. From an initial 738 publications, only 27 met the search criteria of describing the relationship between aggression, brain alterations and traumatic brain injury. Results: These findings showed that traumatic brain injury (TBI) is related to changes in behavior, personality and mood. Conclusions: The development of aggressive and criminal behavior is associated with multiple factors, including the etiology of injury, environmental, psychosocial and personality factors and age at the time of trauma.
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Affiliation(s)
- Giuseppa Maresca
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy (V.L.B.); (C.F.); (D.L.); (F.C.)
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy (V.L.B.); (C.F.); (D.L.); (F.C.)
| | | | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy (V.L.B.); (C.F.); (D.L.); (F.C.)
| | - Caterina Formica
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy (V.L.B.); (C.F.); (D.L.); (F.C.)
| | - Desiree Latella
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy (V.L.B.); (C.F.); (D.L.); (F.C.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy (V.L.B.); (C.F.); (D.L.); (F.C.)
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy (V.L.B.); (C.F.); (D.L.); (F.C.)
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Veliz PT, Berryhill ME. Gender Differences in Adolescents' Affective Symptoms and Behavioral Disorders After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:308-318. [PMID: 36689685 DOI: 10.1097/htr.0000000000000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Mild traumatic brain injuries (mTBI) are considered self-limiting and full recovery is expected. Recent studies identify deficits persisting years after mTBI. Large-scale prospective data permit testing the hypothesis that mTBI increases incidence of affective and behavioral symptoms after new, past , or new and past mTBI. SETTING The study involved secondary analyses of survey responses from the Adolescent Brain Cognitive Development (ABCD) Study. PARTICIPANTS Adolescents in the ABCD Study ( n = 11 869; Wave 1, aged 9-10 years; Wave 2, aged 11-12 years) whose parents reported a new ( n = 157), past ( n = 1318), or new and past ( n = 50) mTBI on the Ohio State University Traumatic Brain Injury Identification Method short form were compared with controls who had no history of mTBI ( n = 9,667). DESIGN Multivariable binary logistic regression models examined associations between a new, past, or new and past mTBI and current affective (aggression, depression, anxiety) and behavioral (somatic, thought, social, attention, attention deficit hyperactivity disorder, conduct) disorders while controlling for demographic factors and baseline symptoms. MAIN MEASURES The primary measure was parental reports of psychiatric and behavioral symptoms on the Child Behavior Checklist. RESULTS Girls exhibited no significant effects after a new mTBI, although a past mTBI increased anxiety (adjusted odds ratios [aOR] = 1.83, 95% confidence interval [CI: 1.15-2.90]) and attention (1.89 [1.09-3.28]) problems. Girls with new and past mTBIs reported elevated anxiety (17.90 [4.67-68.7]), aggression (7.37 [1.49-36.3]), social (9.07 [2.47-33.30]), thought (7.58 [2.24-25.60]), and conduct (6.39 [1.25-32.50]) disorders. In boys, new mTBI increased aggression (aOR = 3.83, 95% CI [1.42-10.30]), whereas past mTBI heightened anxiety (1.91 [1.42-2.95]), but new and past mTBIs had no significant effects. CONCLUSION Adolescents are at greater risk of affective and behavioral symptoms after an mTBI. These effects differ as a function of gender and time of injury. Extended screening for mTBI history and monitoring of affective and behavioral disorders after mTBI in adolescents are warranted.
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Affiliation(s)
- Philip T Veliz
- School of Nursing, University of Michigan, Ann Arbor (Dr Veliz); and Department of Psychology, Programs in Cognitive and Brain Sciences, and Integrative Neuroscience, University of Nevada, Reno (Dr Berryhill)
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7
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Sheth C, Huber RS, Renshaw PF, Yurgelun-Todd DA, McGlade EC. Mild Traumatic Brain Injury and Behavior and Sleep Among 9- and 10-Year Old Children: Initial Findings From the Adolescent Brain Cognitive Development (ABCD) Study. THE JOURNAL OF EARLY ADOLESCENCE 2023; 43:720-745. [PMID: 37780352 PMCID: PMC10540300 DOI: 10.1177/02724316221117508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
There has been concern about the potential sequelae of mild traumatic brain injury (mTBI) in children. This study used data from the Adolescent Brain Cognitive DevelopmentSM (ABCD) study to investigate associations between mTBI and behavior and sleep in school-aged children. Generalized additive mixed models were run to examine the association between TBI and parent-reported Child Behavior Checklist and Sleep Disturbance Scale for Children scores. mTBI with or without loss of consciousness (LOC) in 9- and 10-year old children was associated with 1) higher internalizing, externalizing and total problems and 2) greater sleep disturbance scores on the CBCL. The study also demonstrated a higher incidence of mTBI with and without LOC in boys compared to girls. This study shows a statistically significant but modest association between mTBI and behavioral and sleep changes, suggesting that in a non-clinical, sociodemographically diverse community sample of school-aged children mTBI does not result in clinically significant behavioral or psychological sequelae.
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Affiliation(s)
- Chandni Sheth
- School of Medicine, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Rebekah S. Huber
- School of Medicine, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Perry F. Renshaw
- School of Medicine, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA
- Veterans Affairs VISN 19 Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA
| | - Deborah A. Yurgelun-Todd
- School of Medicine, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA
- Veterans Affairs VISN 19 Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA
| | - Erin C. McGlade
- School of Medicine, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Diagnostic Neuroimaging Laboratory, University of Utah, Salt Lake City, UT, USA
- Veterans Affairs VISN 19 Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, UT, USA
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Chukhlovina ML, Chukhlovin AA. [Features of the patient management with traumatic brain injury]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:145-151. [PMID: 34693703 DOI: 10.17116/jnevro2021121091145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of our study was to consider features of pathogenesis, diagnosis and therapy of traumatic brain injury (TBI) from the viewpoint of neurologist. The mechanisms of emerging injury of the central nervous system, including neuro-inflammation and oxidative stress in patients with TBI, and correlations between clinical manifestations and severity of TBI are discussed. Special attention is paid to the description of certain TBI consequences, e.g. structural drug-resistant epilepsy and post-traumatic stress disorder. We provide evidence for difficulties and lesser availability of rehabilitation programs to patients with TBI during COVID-19 pandemics. One should mention a need for administration of Mexidol as the antioxidant/antihypoxant drug into complex therapy of TBI in such patients. In the period of COVID-19 pandemics, the role of neurologist in management of TBI patients still increases, especially, at the outpatient treatment stage, and when carrying out therapy and medical rehabilitation programs.
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Affiliation(s)
- M L Chukhlovina
- Almazov National Medical Research Center, Ministry of Healthcare, St. Petersburg, Russia
| | - A A Chukhlovin
- Polenov Russian Research Neurosurgical Institute - Branch Almazov National Medical Research Center, St. Petersburg, Russia
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Ewing-Cobbs L, Montroy JJ, Clark AE, Holubkov R, Cox CS, Keenan HT. As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury. Front Neurol 2021; 12:687740. [PMID: 34290664 PMCID: PMC8287068 DOI: 10.3389/fneur.2021.687740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes. Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4-15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire. Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery. Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Janelle J. Montroy
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Amy E. Clark
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard Holubkov
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Charles S. Cox
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Heather T. Keenan
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
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