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Palavani LB, Bertani R, de Barros Oliveira L, Batista S, Verly G, Andreão FF, Ferreira MY, Paiva WS. A Systematic Review and Meta-Analysis on the Management and Outcome of Isolated Skull Fractures in Pediatric Patients. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1913. [PMID: 38136115 PMCID: PMC10741641 DOI: 10.3390/children10121913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF). MATERIALS AND METHODS This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered. RESULTS A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies. CONCLUSIONS Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.
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Affiliation(s)
- Lucca B. Palavani
- Faculty of Medicine, Max Planck University Center, Indaiatuba 13343-060, Brazil;
| | - Raphael Bertani
- Faculty of Medicine, São Paulo University, São Paulo 05508-220, Brazil
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
| | - Gabriel Verly
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
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Li D, Chen J, Weng C, Huang X. Impact of the severity of brain injury on secondary adrenal insufficiency in traumatic brain injury patients and the influence of HPA axis dysfunction on prognosis. Int J Neurosci 2023:1-10. [PMID: 37933491 DOI: 10.1080/00207454.2023.2280450] [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: 09/29/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To investigate secondary adrenal insufficiency post varying traumatic brain injuries' and its impact on prognosis. METHODS 120 traumatic brain injury patients were categorized into mild, moderate and severe groups based on Glasgow Coma Scale. Adrenal function was evaluated through testing. RESULTS Secondary adrenal insufficiency rates were 0% (mild), 22.85% (moderate) and 44.82% (severe). Hypothalamus-pituitary-adrenal axis dysfunction rates were 14.81% (mild), 42.85% (moderate) and 63.79% (severe). Differences among groups were significant (p < .05). Patients with intact hypothalamus-pituitary-adrenal axis had shorter hospital stays and higher Glasgow Coma Scale scores. Receiver operating characteristic analysis of 24-h urinary free cortisol showed an area of 0.846, with a 17.62 μg/24h cutoff, 98.32% sensitivity and 52.37% specificity. In the low-dose adrenocorticotropic hormone test, with an 18 μg/dL cutoff, the receiver operating characteristic area was 0.546, with 46.28% sensitivity and 89.39% specificity. CONCLUSION As traumatic brain injury severity increases, secondary adrenal insufficiency incidence rises. The low-dose adrenocorticotropic hormone test is promising for hypothalamus-pituitary-adrenal axis evaluation. Patients with hypothalamus-pituitary-adrenal dysfunction experience prolonged hospitalization and worse prognosis.
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Affiliation(s)
- Dongping Li
- Critical Care Medicine Department (ICU), Affiliated Hospital of Putian University, Putian, China
| | - Jianhui Chen
- Critical Care Medicine Department (ICU), Affiliated Hospital of Putian University, Putian, China
| | - Chunfa Weng
- Critical Care Medicine Department (ICU), Affiliated Hospital of Putian University, Putian, China
| | - Xiaohai Huang
- Critical Care Medicine Department (ICU), Affiliated Hospital of Putian University, Putian, China
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Bozer JJ, Gruber MD, Letson MM, Crichton KG, Rice CE, Qureshi N, Leonard JR, Sribnick EA. Long-Term Functional Outcome Following Neurosurgical Intervention for Suspected Abusive Head Trauma. Pediatr Neurol 2023; 148:101-107. [PMID: 37699270 DOI: 10.1016/j.pediatrneurol.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the long-term functional and neurodevelopmental outcomes in pediatric patients who underwent neurosurgical intervention following suspected abusive head trauma (AHT). METHODS We performed a single-center retrospective review (January 1, 2007, to December 31, 2019) of patients aged less than three years who had intracranial injury suspicious for AHT and received a neurosurgical procedure. Long-term functional outcome was measured using the Pediatric Cerebral Performance Category (PCPC), Pediatric Overall Performance Category (POPC), and the Mullen Scales of Early Learning (MSEL). RESULTS Seventy-seven patients were identified; 53 survived to discharge and had at least one-year follow-up. To examine long-term functional outcome, PCPC at the last available visit was examined and found to be 1 or 2 (normal to mild disability) for 64% of patients and 3 or 4 (moderate to severe disability) for 36%. The last available MSEL composite score for neurodevelopmental assessment also demonstrated that 13% of patients scored in the "average" range, 17% in the "below average" range, and 70% in the "very low" range. There was no statistical difference in the last available PCPC or POPC score or the last available MSEL score for patients who received a craniotomy when compared with those who received an intracranial shunt. CONCLUSIONS For patients with AHT who survived to discharge, functional improvements over time were noted in both patients who received craniotomy or who simply required shunt placement. These results suggest that, for patients who survive to discharge, operative management of AHT can lead to reasonable long-term functional outcomes.
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Affiliation(s)
- Jordan J Bozer
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Maxwell D Gruber
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Megan M Letson
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Kristin G Crichton
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Courtney E Rice
- Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Jeffrey R Leonard
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Eric A Sribnick
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Rhodes HX, Berg G, Shadiack AL, Thomas KD, Horawski JL, Boyer G, Kleist SM, Worthley AI, Rosenberg DI, Gutovitz SB, Helmrich GA, Biswas S, Pepe AP. Predicting Complicated Mild Traumatic Brain Injury in Adolescent Trauma to Enhance Clinical Decisions in Imaging. J Trauma Nurs 2023; 30:150-157. [PMID: 37144804 DOI: 10.1097/jtn.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury algorithm is used to identify children at low risk of clinically significant traumatic brain injuries to reduce computed tomography (CT) exposure. Adapting PECARN rules based on population-specific risk stratification has been suggested to improve diagnostic accuracy. OBJECTIVE This study sought to identify center-specific patient variables, beyond PECARN rules, that may enhance the identification of patients requiring neuroimaging. METHODS This single-center, retrospective cohort study was conducted from July 1, 2016, to July 1, 2020, in a Southwestern U.S. Level II pediatric trauma center. The inclusion criteria were adolescents (10-15 years), Glasgow Coma Scale (13-15), with a confirmed mechanical blow to the head. Patients without a head CT were excluded. Logistic regression was performed to identify additional complicated mild traumatic brain injury predictor variables beyond the PECARN. RESULTS There were 136 patients studied; 21 (15%) presented with a complicated mild traumatic brain injury. Relative to motorcycle collision or all-terrain vehicle trauma (odds ratio [OR] 211.75, 95% confidence interval, CI [4.51, 9931.41], p < .001), an unspecified mechanism (OR 42.0, 95% CI [1.30, 1350.97], p = .03) and consult activation (OR 17.44, 95% CI [1.75, 173.31], p = .01) were significantly associated with complicated mild traumatic brain injury. CONCLUSIONS We identified additional factors associated with complex mild traumatic brain injury, including motorcycle collision and all-terrain vehicle trauma, unspecified mechanism, and consult activation that are not in the PECARN imaging decision rule. Adding these variables may aid in determining the need for appropriate CT scanning.
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Affiliation(s)
- Heather X Rhodes
- Department of Trauma (Drs Rhodes, Pepe, and Biswas), Department of Family Medicine (Drs Shadiack, Thomas, and Horawski), Department of Surgery (Dr Boyer), Department of Emergency Medicine (Drs Kleist and Gutovitz), Department of Trauma (Mr Worthley), Department of Pediatrics (Dr Rosenberg), CMO, Administration (Dr Helmrich), Grand Strand Medical Center, Myrtle Beach, South Carolina; and Department of Trauma, Wesley Medical Center, Wichita, Kansas (Dr Berg)
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Timeout? The Epidemiology of Pediatric Sports Injuries During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00011. [PMID: 35394980 PMCID: PMC9000043 DOI: 10.5435/jaaosglobal-d-21-00092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022]
Abstract
Background: The COVID-19 pandemic resulted in closure of schools and playgrounds while requiring social distancing, changes that likely affected youth sports participation. The purpose of this study was to identify changes in the epidemiology of pediatric sports injuries during the COVID-19 pandemic. Methods: This retrospective cohort study included patients between the ages of 4 and 18 years who presented to orthopaedic clinics within a single children's hospital network with an acute injury sustained during athletic activity between March 20, 2020, and June 3, 2020 (the strictest period of state-level shelter-in-place orders). These patients were compared with those within the same dates in 2018 and 2019. Chi square and Mann-Whitney U tests were used, as appropriate. Results: Significantly less sports injuries were seen during the pandemic (n = 257) compared with the same dates in 2018 (n = 483) and 2019 (n = 444) despite more providers available in 2020 (P < 0.001). During the pandemic, patients with sports injuries were younger (median age 11 versus 13 years, P < 0.001) and had less delay in presentation (median 5 versus 11 days, P < 0.001). A higher proportion were White (66.9% versus 47.7%, P < 0.001), privately insured (63.4% versus 48.3%, P < 0.001), and seen at a nonurban location (63.4% versus 50.2%, P < 0.001). Most sports injuries during the pandemic were fractures (83.7%). Although 71.4% of all injuries in the prepandemic period occurred in the context of formal sports, only 15.2% were sustained in a formal athletic context in 2020 (P < 0.001). The frequency of surgical treatment was higher during the pandemic (14.8% versus 7.8%, P = 0.001), mainly because most of these injuries were fractures requiring surgical intervention. Conclusions: Fewer sports injuries were seen in the outpatient setting during the COVID-19 pandemic, and most of these injuries were fractures and occurred outside of organized sports settings. Patients were more likely to be White, privately insured, and seen at a nonurban location.
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Yumul JN, Crowe L, Catroppa C, Anderson V, McKinlay A. Post-concussive Signs and Symptoms in Preschool Children: A Systematic Review. Neuropsychol Rev 2021; 32:631-650. [PMID: 34390464 DOI: 10.1007/s11065-021-09518-z] [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: 09/04/2020] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is known about their experience of post-concussive signs and symptoms. This systematic review aims to identify post-concussive signs and symptoms experienced by preschool children up to 12 months post-injury, and to review the methods used to report this data. Relevant findings, including rates, progression, and possible predictors of post-concussive signs and symptoms were also identified. Databases (Ovid MEDLINE, EMBASE, PsycInfo, PubMed, Scopus) and reference lists were searched for relevant articles, which were screened based on specified criteria. Eleven articles met the inclusion criteria, being original studies published in English and presenting data on post-concussive signs and symptoms specific to preschool children with mTBI. Most reviewed studies investigated acute presentations of mTBI, and identified that preschool children demonstrate post-concussive symptoms (PCS) similar to other age groups. Post-traumatic amnesia duration of approximately one day was reported in preschool children following mTBI, as were changes in mood and behavior during the recovery period. Parents were the main informants, with data obtained through either interview or questionnaire. Review findings highlight the lack of empirical data regarding the presentation and progression of PCS in preschoolers following mTBI and evidence on how to best manage this group during recovery.
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Affiliation(s)
- Joy Noelle Yumul
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia.
| | - Louise Crowe
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Cathy Catroppa
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Psychology, University of Canterbury, Christchurch, New Zealand
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An Analysis of Intracranial Hemorrhage in Wartime Pediatric Casualties. World Neurosurg 2021; 154:e729-e733. [PMID: 34343690 DOI: 10.1016/j.wneu.2021.07.128] [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: 06/30/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children make up a significant cohort of patients treated at combat support hospitals. Where traumatic head injury, including intracranial hemorrhage (ICH), is well studied in military adults, such research is lacking regarding pediatric patients. We seek to describe the incidence and outcomes of ICH within this population. METHODS This is a secondary analysis of a previously published dataset from the Department of Defense Trauma Registry for all pediatric casualties in Iraq and Afghanistan from January 2007 to January 2016. Within our dataset, we searched for casualties with an ICH. RESULTS Of the 3439 pediatric encounters in our dataset, we identified 495 (14%) casualties that had at least 1 type of ICH. Most were between 5 and 12 years of age, male (74%), and injured by an explosive (42%). Of the casualties with ICHs, 82 had epidural (16.6%), 237 had subdural (47.9%), 153 had subarachnoid (30.9%), 157 had parenchymal bleeds (31.7%), and 239 had ICHs not otherwise specified (48.3%). In the hospital setting, the epidural group was more frequently treated with skull decompression (41%) and craniotomy with skull elevation (28%). The subdural group was more frequently treated with a craniectomy (17%) and the parenchymal group had more frequent intracranial pressure monitoring (18%). In our dataset, 22 received ketamine prehospital (4.4%) and most were discharged alive from the hospital (79%). CONCLUSIONS Within our dataset, we identified 495 cases of ICH in pediatric patients. Most survived to hospital discharge despite less than half undergoing a decompression procedure.
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