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Jordan J, Ladores S, Kong M, Smith T, Li P, Reuter-Rice K. Association between Day-to-Day Pulsatility Index Change and Neurocognitive Outcomes in Pediatric Traumatic Brain Injury. Neurotrauma Rep 2022; 3:369-376. [PMID: 36204387 PMCID: PMC9531876 DOI: 10.1089/neur.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality in children despite advances in prevention and mitigation strategies. Transcranial Doppler (TCD) ultrasound measures cerebral arterial circulation and allows for the calculation of pulsatility indices (PIs), which provides an assessment of cerebral blood flow changes. Yet, the use of PIs in children with TBI is not well understood. In this study, we defined the day-to-day (DTD) PI change of the anterior cerebral circulation and describe its relationship with injury characteristics and neurocognitive outcomes in children with TBI. A prospective observational parent study of 42 children, 2 months to 15 years of age, with mild or moderate-severe TBI who had serial TCDs provided data for this analysis. Both the mean and variation of DTD PI change were evaluated in the context of injury severity, injury sidedness, and neurocognitive outcome. In those with a unilateral injury, a larger mean DTD PI change in both the injured and uninjured side was found in those with a worse Glasgow Outcome Scale-Extended Pediatrics score at discharge. A larger variation in PI was associated with a worse neurocognitive outcome, irrespective of injury severity. Therefore, the mean and variation of DTD PI change may serve as a potential cerebral vascular biomarker of ongoing secondary injury. The use of PI measurements in the monitoring of children with TBI may provide clinicians with new diagnostic and prognostic insights to inform therapeutic interventions and recovery strategies. However, a larger prospective study is needed to confirm these findings and elucidate potential mechanistic links between DTD PI and clinical outcome measures. To our knowledge, this study is the first of its kind to evaluate the use of PI changes in cerebral vasculature in pediatric TBI patients admitted to the hospital.
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Affiliation(s)
- Jeremy Jordan
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pediatric Critical Care Medicine, Children's of Alabama, Birmingham, Alabama, USA
| | - Sigrid Ladores
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michele Kong
- Pediatric Critical Care Medicine, Children's of Alabama, Birmingham, Alabama, USA
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tedra Smith
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peng Li
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Deana C, Vetrugno L, Stefani F, Bassi F, Bove T. Transcranial Doppler in a child: A most valuable imaging modality. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:167-172. [PMID: 35509297 PMCID: PMC9058393 DOI: 10.1177/1742271x21998059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/01/2021] [Indexed: 05/03/2023]
Abstract
Introduction Pediatric brain injury is a common cause of emergency department (ED) referral. Although severe traumatic brain damage is less frequent, it could be primarily managed by non-pediatric critical care physicians called in for advice. Clinical evaluation is important, but radiology is of particular value in the case of severe brain injury. Transcranial Doppler may help the physician through neuromonitoring. Case Report We report the case of a 3-year-old male child brought into the pediatric ED for a moderate head injury. His neurological status deteriorated rapidly, making endotracheal intubation and mechanical ventilation necessary. Computed tomography (CT) of the head revealed brain contusion and post-traumatic subarachnoidal hemorrhage. Discussion Transcranial Doppler was performed at the standard transtemporal evaluation window, and it showed normal vascularization of the entire anterior brain. This result permitted performance of the control CT scan to be postponed. In this case, basic knowledge of transcranial ultrasound proved to be useful, and we believe it could also be useful to other colleagues faced with similar situations even if they are not dedicated to pediatric critically ill patients. Conclusion Doppler ultrasound in the pediatric population is a valuable bedside tool. Together with clinical evaluation and radiology, it completes the set of techniques necessary for continuous neuromonitoring.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Cristian Deana, Anesthesia and Intensive Care 1, Anesthesia and Intensive Care Department, Academic Hospital S. Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale S. M. della Misericordia, 15 - 33100 Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Medical Department, University of Udine, Udine, Italy
| | - Francesca Stefani
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Medical Department, University of Udine, Udine, Italy
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Wang T, Chen Y, Du H, Liu Y, Zhang L, Meng M. Monitoring of Neuroendocrine Changes in Acute Stage of Severe Craniocerebral Injury by Transcranial Doppler Ultrasound Image Features Based on Artificial Intelligence Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:3584034. [PMID: 34956395 PMCID: PMC8694971 DOI: 10.1155/2021/3584034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022]
Abstract
This study was aimed at exploring the application value of transcranial Doppler (TCD) based on artificial intelligence algorithm in monitoring the neuroendocrine changes in patients with severe head injury in the acute phase; 80 patients with severe brain injury were included in this study as the study subjects, and they were randomly divided into the control group (conventional TCD) and the experimental group (algorithm-optimized TCD), 40 patients in each group. An artificial intelligence neighborhood segmentation algorithm for TCD images was designed to comprehensively evaluate the application value of this algorithm by measuring the TCD image area segmentation error and running time of this algorithm. In addition, the Glasgow coma scale (GCS) and each neuroendocrine hormone level were used to assess the neuroendocrine status of the patients. The results showed that the running time of the artificial intelligence neighborhood segmentation algorithm for TCD was 3.14 ± 1.02 s, which was significantly shorter than 32.23 ± 9.56 s of traditional convolutional neural network (CNN) algorithms (P < 0.05). The false rejection rate (FRR) of TCD image area segmentation of this algorithm was significantly reduced, and the false acceptance rate (FAR) and true acceptance rate (TAR) were significantly increased (P < 0.05). The consistent rate of the GCS score and Doppler ultrasound imaging diagnosis results in the experimental group was 93.8%, which was significantly higher than the 80.3% in the control group (P < 0.05). The consistency rate of Doppler ultrasound imaging diagnosis results of patients in the experimental group with abnormal levels of follicle stimulating hormone (FSH), prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH), and thyroid stimulating hormone (TSH) was significantly higher than that of the control group (P < 0.05). In summary, the artificial intelligence neighborhood segmentation algorithm can significantly shorten the processing time of the TCD image and reduce the segmentation error of the image area, which significantly improves the monitoring level of TCD for patients with severe craniocerebral injury and has good clinical application value.
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Affiliation(s)
- Tao Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Yizhu Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Hangxiang Du
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Yongan Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Lidi Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Mei Meng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
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O'Brien NF, Reuter-Rice K, Wainwright MS, Kaplan SL, Appavu B, Erklauer JC, Ghosh S, Kirschen M, Kozak B, Lidsky K, Lovett ME, Mehollin-Ray AR, Miles DK, Press CA, Simon DW, Tasker RC, LaRovere KL. Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement. J Pediatr Intensive Care 2021; 10:133-142. [PMID: 33884214 PMCID: PMC8052112 DOI: 10.1055/s-0040-1715128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
Transcranial Doppler ultrasonography (TCD) is being used in many pediatric intensive care units (PICUs) to aid in the diagnosis and monitoring of children with known or suspected pathophysiological changes to cerebral hemodynamics. Standardized approaches to scanning protocols, interpretation, and documentation of TCD examinations in this setting are lacking. A panel of multidisciplinary clinicians with expertise in the use of TCD in the PICU undertook a three-round modified Delphi process to reach unanimous agreement on 34 statements and then create practice recommendations for TCD use in the PICU. Use of these recommendations will help to ensure that high quality TCD images are captured, interpreted, and reported using standard nomenclature. Furthermore, use will aid in ensuring reproducible and meaningful study results between TCD practitioners and across PICUs.
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Affiliation(s)
- Nicole Fortier O'Brien
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States
| | - Karin Reuter-Rice
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, School of Nursing, Duke University, Duke Institute for Brain Sciences, North Carolina, United States
| | - Mark S. Wainwright
- Department of Neurology, University of Washington, Seattle Children's Hospital, Washington, United States
| | - Summer L. Kaplan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Brian Appavu
- Department of Pediatrics, Division of Critical Care Medicine, Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine—Phoenix, Arizona, United States
| | - Jennifer C. Erklauer
- Department of Pediatrics, Division of Critical Care Medicine and Neurology, Baylor College of Medicine, Texas Children's Hospital, Texas, United States
| | - Suman Ghosh
- Department of Pediatrics, Division of Pediatric Neurology, University of Florida, College of Medicine, Florida, United States
| | - Matthew Kirschen
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Neurology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Brandi Kozak
- Department of Radiology, Ultrasound Division, Center for Pediatric Contrast Ultrasound, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Karen Lidsky
- Department of Pediatrics, Division of Pediatric Critical Care, Wolfson Children's Hospital, University of Florida, Florida, United States
| | - Marlina Elizabeth Lovett
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States
| | - Amy R. Mehollin-Ray
- Department of Radiology, Baylor College of Medicine, E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Texas, United States
| | - Darryl K. Miles
- Department of Pediatrics/Division of Critical Care, UT Southwestern Medical Center, Texas, United States
| | - Craig A. Press
- Department of Pediatrics, Section of Child Neurology, University of Colorado, Children's Hospital Colorado, Colorado, United States
| | - Dennis W. Simon
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pennsylvania, United States
| | - Robert C. Tasker
- Departments of Neurology & Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States
| | - Kerri Lynn LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States
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5
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Steinman J, Cahill LS, Stortz G, Macgowan CK, Stefanovic B, Sled JG. Non-Invasive Ultrasound Detection of Cerebrovascular Changes in a Mouse Model of Traumatic Brain Injury. J Neurotrauma 2020; 37:2157-2168. [PMID: 32326817 DOI: 10.1089/neu.2019.6872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) can induce changes in vascular architecture. Although ultrasound metrics such as pulsatility index (PI) are sensitive to changes in hemodynamic resistance downstream from major arteries, these metrics depend on features unrelated to vessel architecture, such as blood pressure and heart rate. In contrast, input impedance and reflection coefficient that are derived from wave reflection theory seek to minimize the effects of altered cardiac output or heart rate. In this article, we investigate the use of ultrasound to assess changes in vascular impedance and wave reflection in the common carotid arteries of mice exposed to a controlled cortical impact. Focusing on the first harmonics of the reflected waves, the impedance phase was increased ipsilaterally in impacted mice compared with shams, whereas the magnitude of the impedance was unchanged. In contrast, PI was reduced bilaterally. Interestingly, PI and the first harmonic magnitude of input impedance in the carotid artery were correlated on the contralateral but not ipsilateral side. We investigated the use of these metrics to classify mice as sham or TBI, finding an area under the receiver operating characteristic curve ipsilaterally of 0.792 (confidence interval [CI]: 0.648-0.936) for correct classification with first harmonic impedance magnitude and phase as predictors and 0.716 (CI: 0.553-0.879) using carotid artery PI and diameter as predictors. Overall, the findings support the use of wave reflection analysis as a more specific measure of vascular changes following TBI and motivate the translation of this approach for monitoring vascular changes in humans affected by TBI.
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Affiliation(s)
- Joe Steinman
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay S Cahill
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Chemistry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Greg Stortz
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Bojana Stefanovic
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - John G Sled
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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Transcranial Doppler Ultrasound During Critical Illness in Children: Survey of Practices in Pediatric Neurocritical Care Centers. Pediatr Crit Care Med 2020; 21:67-74. [PMID: 31568242 DOI: 10.1097/pcc.0000000000002118] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The scope of transcranial Doppler ultrasound in the practice of pediatric neurocritical care is unknown. We have surveyed pediatric neurocritical care centers on their use of transcranial Doppler and analyzed clinical management practices. DESIGN Electronic-mail recruitment with survey of expert centers using web-based questionnaire. SETTING Survey of 43 hospitals (31 United States, 12 international) belonging to the Pediatric Neurocritical Care Research Group. PATIENTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A 67% (29/43) hospital-response rate. Of these centers, 27 reported using transcranial Doppler in the PICU; two hospitals opted out due to lack of transcranial Doppler availability/use. The most common diagnoses for using transcranial Doppler in clinical care were intracranial/subarachnoid hemorrhage (20 hospitals), arterial ischemic stroke (14 hospitals), and traumatic brain injury (10 hospitals). Clinical studies were carried out and interpreted by credentialed individuals in 93% (25/27) and 78% (21/27) of the centers, respectively. A written protocol for performance of transcranial Doppler in the PICU was available in 30% (8/27 hospitals); of these, two of eight hospitals routinely performed correlation studies to validate results. In 74% of the centers (20/27), transcranial Doppler results were used to guide clinical care: that is, when to obtain a neuroimaging study (18 hospitals); how to manipulate cerebral perfusion pressure with fluids/vasopressors (13 hospitals); and whether to perform a surgical intervention (six hospitals). Research studies were also commonly performed for a range of diagnoses. CONCLUSIONS At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
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7
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Masaeli M, Chahardoli M, Azizi S, Shekarchi B, Sabzghabaei F, Shekar Riz Fomani N, Azarmnia M, Abedi M. Point of Care Ultrasound in Detection of Brain Hemorrhage and Skull Fracture Following Pediatric Head Trauma; a Diagnostic Accuracy Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e53. [PMID: 31875207 PMCID: PMC6905422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Head trauma is a common reason for emergency department visits worldwide; many of which involve young children. We sought to determine if head ultrasound (US), as a portable, fast and safe modality, can guide diagnosis and treatment of children in emergency settings. METHODS In this cross-sectional study, brain computed tomography (CT) scan and emergency head US were performed on head trauma children who were referred to the emergency departments of Firouzgar and Besat Hospitals, Tehran, Iran, from September 2018 to May 2019. The findings of the two modalities were separately evaluated, and used to estimate the diagnostic accuracy of US. RESULTS 538 patients with the mean age of 5.6 ± 4.9 (0-18) years were studied (54.8% male). Sensitivity and specificity of bedside US in detection of hemorrhage were 85.71% (42.13%-99.64%) and 97.99% (94.23%-99.58%) for children below the age of 2. These measures were 80.00% (51.91%-95.67%) and 97.97% (94.88%-99.44%), respectively, for those between 2 and 6 years old and 46.67% (21.27%-73.41%) and 92.90% (87.66%-96.40%), respectively, for those above the age of 6. Sensitivity and specificity were 92.31% (84.01%-97.12%) and 95.87% (93.62%-97.50%), respectively, in diagnosing skull fractures. Cohen's kappa coefficient varied greatly for different findings, ranging from 0.363 to 0.825, indicating different agreement rates for each. CONCLUSION Based on our findings, emergency US can play a greater role in the initial management of head trauma children, especially as a triage test.
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Affiliation(s)
- Maryam Masaeli
- Emergency Department, Besat Hospital, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mojtaba Chahardoli
- Emergency Department, Firouzgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sepehr Azizi
- Emergency Department, Besat Hospital, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.,Emergency Department, Firouzgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Sepehr Azizi; Emergency Department, Besat Hospital, School of Medicine, AJA University of Medical Sciences, Tehran, Iran. ORCID: https://orcid.org/0000-0002-2342-1110 ,
| | - Babak Shekarchi
- Department of Radiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Foroogh Sabzghabaei
- Department of Medicine, Firouzgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Shekar Riz Fomani
- Emergency Department, Firouzgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Azarmnia
- Emergency Department, Besat Hospital, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mahdis Abedi
- Emergency Department, Firouzgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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8
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Deines JJ, Chang J, Reuter-Rice K. Cerebral Blood Flow Velocities and Functional Outcomes in Pediatric Mild Traumatic Brain Injury. J Neurotrauma 2018; 36:135-141. [PMID: 30044180 PMCID: PMC6306683 DOI: 10.1089/neu.2017.5577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Outcomes can be challenging to predict in children with mild traumatic brain injury (TBI). Transcranial Doppler (TCD) ultrasound has become an increasingly useful modality in adult and pediatric TBI by measuring blood flow velocities within the circle of Willis. In children with moderate-to-severe TBI, multiple studies have correlated abnormal TCD measurements and poor outcomes. Additionally, TCD has shown value in assessing adults with mild brain injury. To date, there are no studies that correlate TCD findings and outcomes in children with mild TBI. We hypothesize that altered cerebral blood flow after mild TBI is associated with poor functional outcome using the Glasgow Outcome Scale-Extended, Pediatrics (GOS-E Peds). TCD was performed within 24 h of admission on 60 patients at a tertiary Level 1 children's hospital. A secondary analysis was performed on the subgroup of 28 mild TBI patients. GOS-E Peds was measured at the time of hospital discharge and 4-6 weeks post-discharge. Cerebral blood flow velocities did not show correlation with outcome. At discharge, the right-sided Spearman's correlation coefficient was 0.19 (p value = 0.33) and the left-sided was 0.36 (p = 0.06). At follow up the right-sided coefficient was -0.04 (p = 0.84), the left-sided was -0.25 (p = 0.24). Pulsatility index likewise showed no correlation. Right and left-sided correlation at discharge were -0.25 (p = 0.19) and 0.01 (p = 0.96), respectively. At follow up the right side showed 0.004 (p = 0.99), and the left showed 0.18 (p = 0.41). Although our data did not show correlation, it showed that the investigation could feasibly be done in pediatric patients with mild TBI. The study was limited by small sample size and infrequent outcome of interest. Future studies may help define the role of TCD in the large population of mild pediatric TBI patients.
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Affiliation(s)
- Jake J. Deines
- Department of Pediatrics, Golisano Children's Hospital/University of Rochester, Rochester, New York
| | - Jianhong Chang
- Duke University School of Nursing, Durham, North Carolina
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9
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Abecasis F, Oliveira V, Robba C, Czosnyka M. Transcranial Doppler in pediatric emergency and intensive care unit: a case series and literature review. Childs Nerv Syst 2018; 34:1465-1470. [PMID: 29955941 DOI: 10.1007/s00381-018-3877-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/21/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Transcranial Doppler (TCD) has been used for more than 30 years in clinical practice. Although adult intensive care is relatively well covered, pediatric cases are still underrepresented. We intend to review a series of pediatric cases where TCD was determinant in clinical decisions and a literature review on this topic. METHODS We describe cases with different pathologies where TCD had an important role in clinical management of the patients. We discuss TCD utility and potential role both in the emergency department and the intensive care unit. RESULTS Five patients with different neurologic insults are presented. TCD was useful in the identification of intracranial hypertension in traumatic brain injury, hydrocephalus and central nervous system infection; identification of decreased cerebral perfusion pressure in hypovolemic shock and the diagnosis of impending cerebral circulatory arrest in a child with meningococcal septicemia. We discuss how TCD can be used in emergency and intensive care settings, reviewing relevant literature and our own experience. CONCLUSIONS Non-invasive testing using TCD can aid clinical decisions. More widespread use of this technique will allow for better care of children with neurologic insults.
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Affiliation(s)
- Francisco Abecasis
- Pediatric Intensive Care Unit, Centro Hospitalar Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Vitor Oliveira
- Department of Neurology, Centro Hospitalar Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRSSS for Oncology, Genoa, Italy
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, UK.,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
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10
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Reuter-Rice K, Regier M, Bennett E, Laskowitz D. The Effect of the Relationship of APOE Polymorphisms and Cerebral Vasospasm on Functional Outcomes in Children With Traumatic Brain Injury. Biol Res Nurs 2018; 20:566-576. [PMID: 29996665 DOI: 10.1177/1099800418785982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pediatric traumatic brain injury (TBI) is a leading cause of death and disability. Polymorphisms in the apolipoprotein E ( APOE) gene have been linked to cerebral vasospasm (CV) and poor outcomes in adults with TBI, yet these associations remain poorly defined in children. OBJECTIVE We examined the effect of the relationship between APOE polymorphisms and CV on functional outcomes in children with a TBI. METHOD This prospective, descriptive study examined 60 children (aged 10 days to 15 years) with a TBI. Data included demographic information, genetic sampling for the APOE gene and single-nucleotide polymorphisms (SNPs; rs405509, rs429358, rs7412), and daily transcranial Doppler ultrasounds to evaluate for CV. We examined Glasgow Outcome Scale-Extended Pediatrics (GOS-E Peds) scores at the time of discharge and 4-6 weeks after discharge. RESULTS More than half (56.7%) of the 60 children ( Mage = 5.9 years) were male. Twenty-six participants (43.3%) experienced an occurrence of CV. There were significant differences in injury mechanism (unadjusted p = .048) and age (unadjusted p = .02) between those with and without CV. Also, the noncoding promoter SNP rs405509 T/T, when considered with injury severity, appeared to modify the relationship of APOE genotype to CV. The relationship between APOE and CV had no significant effect on GOS-E Peds scores. CONCLUSION Injury severity and the APOE noncoding promoter SNP rs405509 may modify the relationship between APOE and CV in children with TBI. More studies are needed to understand the role of APOE polymorphisms in outcomes in children with TBI.
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Affiliation(s)
- Karin Reuter-Rice
- 1 Division of Critical Care Medicine, Department of Pediatrics, School of Nursing, Duke University School of Medicine, Durham, NC, USA
| | - Michael Regier
- 2 Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Ellen Bennett
- 3 Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Daniel Laskowitz
- 3 Department of Neurology, Duke University School of Medicine, Durham, NC, USA
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