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Zeller SL, Khan A, Chung JY, Cooper JB, Stewart FD, Salik I, Pisapia JM. Application of Brain Injury Guidelines at a Pediatric Level 1 Trauma Center predicts reliability, safety, and improved resource utilization. Childs Nerv Syst 2024; 40:2769-2774. [PMID: 38858274 DOI: 10.1007/s00381-024-06489-3] [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] [Received: 03/29/2024] [Accepted: 06/01/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE Brain Injury Guidelines (BIG) have been established to guide management related to TBI in adults. Here, BIG criteria were applied to pediatric TBI patients to evaluate reliability, safety, and resource utilization. METHODS A retrospective study was performed on all pediatric TBI patients aged 18 years or younger from January 2012 to July 2023 at a Level 1 Pediatric Trauma Center. The severity of TBI (BIG 1/2/3) was rated by review of initial cranial imaging by two independent observers. Inter-observer reliability was assessed. Predictions based on BIG criteria regarding repeat cranial imaging, ICU admission, and neurosurgical consultation were compared with observations from the cohort. Outcome data was collected, including neurosurgical intervention and mortality rate. RESULTS Three hundred fifty-nine patients were included with mean age of 5.3 years. Injury severity included 44 BIG 1 (12.2%), 170 BIG 2 (47.4%), and 145 BIG 3 injuries (40.4%). Inter-rater reliability was 96.4%. Neurosurgical consultation was obtained in all patients, though only predicted by guidelines in 40.4%. Repeat imaging was obtained in 166 BIG 1/2 patients, with an average of 1.3 CT scans and 0.8 MRIs/rapid MRIs per patient. ICU was utilized in 104 (77.6%) patients not recommended per BIG criteria. Ultimately, 37 patients, all BIG 3, required neurosurgical intervention; no neurosurgical interventions were required in those classified as BIG 1/2. CONCLUSIONS BIG criteria can be applied to pediatric TBI with high inter-observer reliability and without formal neurosurgical training. Retrospective application of BIG predicted fewer imaging studies, ICU admissions, and neurosurgical consults without overlooking patients requiring neurosurgical intervention.
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Affiliation(s)
- Sabrina L Zeller
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA.
| | - Aleena Khan
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Joon Yong Chung
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Jared B Cooper
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA
| | - F Dylan Stewart
- Department of Surgery, Pediatric Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Irim Salik
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY, USA
| | - Jared M Pisapia
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA
- School of Medicine, New York Medical College, Valhalla, NY, USA
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2
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Crozes F, Delpierre C, Costa N. Mapping the costs and socioeconomic characteristics involved in traumatic brain injuries: a scoping review. J Rehabil Med 2024; 56:jrm18311. [PMID: 39101675 PMCID: PMC11318505 DOI: 10.2340/jrm.v56.18311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/26/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE To identify the articles in the existing literature that analyse healthcare costs according to the socioeconomic position (pre- or post-injury) for traumatic brain injury survivors. Secondary aims were to describe the types of costs and socioeconomic characteristics and to determine whether socioeconomic characteristics affect the risk of traumatic brain injury or whether the consequences of trauma alter living conditions post-injury. METHODS This scoping review followed the methods proposed by Arksey and O'Malley. The literature search was performed in 5 databases. RESULTS Twenty-two articles were included, published between 1988 and 2023. Only 2 articles (9%) followed the guidelines for economic evaluation of healthcare programmes and 2 articles (9%) evaluated socioeconomic position "completely" with 3 main individual measures of socioeconomic characteristics (i.e., education, income, and occupation). The relationship between costs and socioeconomic characteristics could vary in 2 ways in traumatic brain injury: socioeconomic disadvantage was mostly associated with higher healthcare costs, and the cost of healthcare reduced the survivors' living conditions. CONCLUSION This work highlights the need for a detailed and methodologically sound assessment of the relationship between socioeconomic characteristics and the costs associated with trauma. Modelling the care pathways of traumatic brain injury would make it possible to identify populations at risk of poor recovery or deterioration following a TBI, and to develop specific care pathways. The aim is to build more appropriate, effective, and equitable care programmes.
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Affiliation(s)
- Fanny Crozes
- Health economic Unit, University Hospital center of Toulouse, Toulouse, France; EQUITY research team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France; Institute of Nursing Training, Toulouse University Hospital, Toulouse, France.
| | - Cyrille Delpierre
- EQUITY research team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Nadège Costa
- Health economic Unit, University Hospital center of Toulouse, Toulouse, France; EQUITY research team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
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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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Tian E, O'Guinn ML, Chen SY, Ourshalimian S, Chaudhari PP, Spurrier RG. Primary caregiver employment status is associated with traumatic brain injury in children in the USA. Inj Prev 2024:ip-2023-045151. [PMID: 39043570 DOI: 10.1136/ip-2023-045151] [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: 10/19/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common injury in children. Previous literature has demonstrated that TBI may be associated with supervision level. We hypothesised that primary caregiver employment would be associated with child TBI. METHODS A retrospective cross-sectional study was performed for children aged 0-17 using the National Survey of Children's Health (NSCH) 2018-2019. The NSCH contains survey data on children's health completed by adult caregivers from randomly selected households across the USA. We compared current TBI prevalence between children from households of different employment statuses. Current TBI was defined by survey responses indicating a healthcare provider diagnosed TBI or concussion for the child and the condition was present at the time of survey completion. Household employment status was categorised as two caregivers employed, two caregivers unemployed, one of two caregivers unemployed, single caregiver employed and single caregiver unemployed. Multivariable logistic regression was performed, controlling for sociodemographic factors. RESULTS Of 56 865 children, median age was 10 years (IQR: 5-14), and 0.6% (n=332) had a current TBI. Children with TBI were older than children without TBI (median 12 years vs 10 years, p<0.001). On multivariable regression, children with at least one caregiver unemployed had increased odds of current TBI compared with children with both caregivers employed. CONCLUSIONS Children with at least one caregiver unemployed had increased TBI odds compared with children with both caregivers employed. These findings highlight a population of families that may benefit from injury prevention education and intervention.
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Affiliation(s)
- Emma Tian
- Children's Hospital Los Angeles, Los Angeles, California, USA
- USC Keck School of Medicine, Los Angeles, California, USA
| | | | | | | | - Pradip P Chaudhari
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California, USA
| | - Ryan G Spurrier
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Surgery, USC Keck School of Medicine, Los Angeles, California, USA
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Malhotra AK, Shakil H, Smith CW, Sader N, Ladha K, Wijeysundera DN, Singhal A, Kulkarni AV, Wilson JR, Witiw CD, Nathens AB. Withdrawal of Life-Sustaining Treatment for Pediatric Patients With Severe Traumatic Brain Injury. JAMA Surg 2024; 159:287-296. [PMID: 38117514 PMCID: PMC10733846 DOI: 10.1001/jamasurg.2023.6531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/13/2023] [Indexed: 12/21/2023]
Abstract
Importance The decision to withdraw life-sustaining treatment for pediatric patients with severe traumatic brain injury (TBI) is challenging for clinicians and families with limited evidence quantifying existing practices. Given the lack of standardized clinical guidelines, variable practice patterns across trauma centers seem likely. Objective To evaluate the factors influencing decisions to withdraw life-sustaining treatment across North American trauma centers for pediatric patients with severe TBI and to quantify any existing between-center variability in withdrawal of life-sustaining treatment practices. Design, Setting, and Participants This retrospective cohort study used data collected from 515 trauma centers through the American College of Surgeons Trauma Quality Improvement Program between 2017 and 2020. Pediatric patients younger than 19 years with severe TBI and a documented decision for withdrawal of life-sustaining treatment were included. Data were analyzed from January to May 2023. Main Outcomes and Measures A random intercept multilevel logistic regression model was used to quantify patient, injury, and hospital characteristics associated with the decision to withdraw life-sustaining treatment; the median odds ratio was used to characterize residual between-center variability. Centers were ranked by their conditional random intercepts and quartile-specific adjusted mortalities were computed. Results A total of 9803 children (mean [SD] age, 12.6 [5.7]; 2920 [29.8%] female) with severe TBI were identified, 1003 of whom (10.2%) had a documented decision to withdraw life-sustaining treatment. Patient-level factors associated with an increase in likelihood of withdrawal of life-sustaining treatment were young age (younger than 3 years), higher severity intracranial and extracranial injuries, and mechanism of injury related to firearms. Following adjustment for patient and hospital attributes, the median odds ratio was 1.54 (95% CI, 1.46-1.62), suggesting residual variation in withdrawal of life-sustaining treatment between centers. When centers were grouped into quartiles by their propensity for withdrawal of life-sustaining treatment, adjusted mortality was higher for fourth-quartile compared to first-quartile centers (odds ratio, 1.66; 95% CI, 1.45-1.88). Conclusions and Relevance Several patient and injury factors were associated with withdrawal of life-sustaining treatment decision-making for pediatric patients with severe TBI in this study. Variation in withdrawal of life-sustaining treatment practices between trauma centers was observed after adjustment for case mix; this variation was associated with differences in risk-adjusted mortality rates. Taken together, these findings highlight the presence of inconsistent approaches to withdrawal of life-sustaining treatment in children, which speaks to the need for guidelines to address this significant practice pattern variation.
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Affiliation(s)
- Armaan K. Malhotra
- Division of Neurosurgery, Unity Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Husain Shakil
- Division of Neurosurgery, Unity Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Christopher W. Smith
- Division of Neurosurgery, Unity Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
| | - Nicholas Sader
- Division of Neurosurgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Karim Ladha
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of Anesthesiology, Unity Health, Toronto, Ontario, Canada
| | - Duminda N. Wijeysundera
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of Anesthesiology, Unity Health, Toronto, Ontario, Canada
| | - Ashutosh Singhal
- Division of Neurosurgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Abhaya V. Kulkarni
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jefferson R. Wilson
- Division of Neurosurgery, Unity Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Christopher D. Witiw
- Division of Neurosurgery, Unity Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Avery B. Nathens
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of General Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Yogo N, Abe T, Kano K, Muto Y, Kiyonaga S, Hirai K. Post-extubation dysphagia in pediatric trauma patients: a single-center case-series study. Sci Rep 2024; 14:3475. [PMID: 38347152 PMCID: PMC10861439 DOI: 10.1038/s41598-024-54247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/10/2024] [Indexed: 02/15/2024] Open
Abstract
We aimed to investigate whether ventilator support time influences the occurrence of dysphagia in pediatric trauma patients. This case-series study was conducted in a single pediatric emergency and critical care center from April 2012 to March 2022. Trauma patients aged < 16 years who underwent tracheal intubation were divided into two groups based on the occurrence of dysphagia within 72 h after extubation, and their data were analyzed. Tracheal intubation was performed in 75 pediatric trauma patients, and 53 of them were included in the analysis. A total of 22 patients had post-extubation dysphagia and head trauma. The dysphagia group tended to have more severe head injuries (Abbreviated Injury Scale (AIS) 4 [4-5] vs. 4 [0-4]; p < 0.05), a longer ventilator support time (7 days [4-11] vs. 1 day [1-2.5]; p < 0.05), and a longer length of hospital stay (27 days [18.0-40.3] vs. 11 days [10.0-21.0]; p < 0.05). Severe head trauma and a long duration of tracheal intubation may be risk factors for dysphagia in pediatric trauma patients. Therefore, early recognition of these risk factors could assist in treatment planning for speech-language pathologist intervention and nutritional routes of administration.
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Affiliation(s)
- Naoki Yogo
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan.
| | - Takeru Abe
- Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kyoko Kano
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan
| | - Yuichiro Muto
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan
| | - Sachi Kiyonaga
- Department of Rehabilitation, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Katsuki Hirai
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan
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Bhat JN, Amato A, Schultz S, Gomez R. Protocol-Based Standardized Endocrinological Evaluation of Children With Traumatic Brain Injury: A Quality Improvement Initiative. Clin Pediatr (Phila) 2024:99228241230390. [PMID: 38327253 DOI: 10.1177/00099228241230390] [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] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Traumatic brain injury (TBI) can disrupt the hypothalamo-pituitary axis, causing neuroendocrine dysfunction. As a third of children can develop post-traumatic hypothalamo-pituitary axis dysfunction (HPAD), a longitudinal follow-up is required in children with TBI. METHOD The study comprised a pre-quality improvement (QI) phase (baseline phase) and a QI phase (post-intervention phase). Retrospective data were collected on children with TBI at our hospital during the pre-QI phase of the study to estimate the baseline data on HPAD prevalence and pediatric endocrine referral rate. Guidance protocol for standardizing the pediatric endocrine referral, evaluation, and follow-up of children with TBI was implemented. Prospective data were collected to estimate outcome measures (prevalence of HPAD, rate of initial endocrine consultation and outpatient follow-up) and process measures (protocol adherence rate). RESULT Twenty-seven children, aged ≤19 years, were admitted with TBI in the pre-QI phase. The median age was 9 years. Motor vehicle accidents predominated. Thirty percent had limited endocrine evaluation, and 4% had transient cranial diabetes insipidus (DI). The QI phase included 8 children. Demographic data were similar to those in the pre-QI phase. Both outcome and process measures increased to 75% from the pre-QI phase following the protocol implementation. CONCLUSION A lower prevalence rate of HPAD in the current cohort may be owing to underevaluation and a smaller sample size. The QI initiative incorporating a guidance protocol-based endocrinological approach to children with TBI improved the pediatric endocrinology referral and follow-up rates.
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Affiliation(s)
- Jayalakshmi Narayan Bhat
- Department of Pediatric Endocrinology, Louisiana State University Health Science Center, Shreveport, LA, USA
- Department of Pediatric Endocrinology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Abbie Amato
- The Gilda Trautman Newman Rehabilitation Center at Children's Hospital, New Orleans, LA, USA
| | - Scott Schultz
- The Gilda Trautman Newman Rehabilitation Center at Children's Hospital, New Orleans, LA, USA
| | - Ricardo Gomez
- Department of Pediatric Endocrinology, Louisiana State University Health Science Center, New Orleans, LA, USA
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Keleher F, Lindsey HM, Kerestes R, Amiri H, Asarnow RF, Babikian T, Bartnik-Olson B, Bigler ED, Caeyenberghs K, Esopenko C, Ewing-Cobbs L, Giza CC, Goodrich-Hunsaker NJ, Hodges CB, Hoskinson KR, Irimia A, Königs M, Max JE, Newsome MR, Olsen A, Ryan NP, Schmidt AT, Stein DJ, Suskauer SJ, Ware AL, Wheeler AL, Zielinski BA, Thompson PM, Harding IH, Tate DF, Wilde EA, Dennis EL. Multimodal Analysis of Secondary Cerebellar Alterations After Pediatric Traumatic Brain Injury. JAMA Netw Open 2023; 6:e2343410. [PMID: 37966838 PMCID: PMC10652147 DOI: 10.1001/jamanetworkopen.2023.43410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Importance Traumatic brain injury (TBI) is known to cause widespread neural disruption in the cerebrum. However, less is known about the association of TBI with cerebellar structure and how such changes may alter executive functioning. Objective To investigate alterations in subregional cerebellum volume and cerebral white matter microstructure after pediatric TBI and examine subsequent changes in executive function. Design, Setting, and Participants This retrospective cohort study combined 12 data sets (collected between 2006 and 2020) from 9 sites in the Enhancing Neuroimaging Genetics Through Meta-Analysis Consortium Pediatric TBI working group in a mega-analysis of cerebellar structure. Participants with TBI or healthy controls (some with orthopedic injury) were recruited from trauma centers, clinics, and institutional trauma registries, some of which were followed longitudinally over a period of 0.7 to 1.9 years. Healthy controls were recruited from the surrounding community. Data analysis occurred from October to December 2022. Exposure Accidental mild complicated-severe TBI (msTBI) for those in the TBI group. Some controls received a diagnosis of orthopedic injury. Main Outcomes and Measures Volume of 18 cerebellar lobules and vermal regions were estimated from 3-dimensional T1-weighted magnetic resonance imaging (MRI) scans. White matter organization in 28 regions of interest was assessed with diffusion tensor MRI. Executive function was measured by parent-reported scores from the Behavior Rating Inventory of Executive Functioning. Results A total of 598 children and adolescents (mean [SD] age, 14.05 [3.06] years; range, 5.45-19.70 years; 386 male participants [64.5%]; 212 female participants [35.5%]) were included in the study, with 314 participants in the msTBI group, and 284 participants in the non-TBI group (133 healthy individuals and 151 orthopedically injured individuals). Significantly smaller total cerebellum volume (d = -0.37; 95% CI, -0.52 to -0.22; P < .001) and subregional cerebellum volumes (eg, corpus medullare; d = -0.43; 95% CI, -0.58 to -0.28; P < .001) were observed in the msTBI group. These alterations were primarily seen in participants in the chronic phase (ie, >6 months postinjury) of injury (total cerebellar volume, d = -0.55; 95% CI, -0.75 to -0.35; P < .001). Smaller cerebellum volumes were associated with higher scores on the Behavior Rating Inventory of Executive Functioning Global Executive Composite score (β = -208.9 mm3; 95% CI, -319.0 to -98.0 mm3; P = .008) and Metacognition Index score (β = -202.5 mm3; 95% CI, -319.0 to -85.0 mm3; P = .02). In a subset of 185 participants with longitudinal data, younger msTBI participants exhibited cerebellum volume reductions (β = 0.0052 mm3; 95% CI, 0.0013 to 0.0090 mm3; P = .01), and older participants slower growth rates. Poorer white matter organization in the first months postinjury was associated with decreases in cerebellum volume over time (β=0.52 mm3; 95% CI, 0.19 to 0.84 mm3; P = .005). Conclusions and Relevance In this cohort study of pediatric msTBI, our results demonstrated robust cerebellar volume alterations associated with pediatric TBI, localized to the posterior lobe. Furthermore, longitudinal cerebellum changes were associated with baseline diffusion tensor MRI metrics, suggesting secondary cerebellar atrophy. These results provide further understanding of secondary injury mechanisms and may point to new opportunities for intervention.
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Affiliation(s)
- Finian Keleher
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Hannah M. Lindsey
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Rebecca Kerestes
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Houshang Amiri
- Institute of Neuropharmacology, Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Robert F. Asarnow
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Brain Research Institute, University of California, Los Angeles
- Department of Psychology, University of California, Los Angeles
| | - Talin Babikian
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
| | - Brenda Bartnik-Olson
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, California
| | - Erin D. Bigler
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- Department of Psychology, Brigham Young University, Provo, Utah
- Neuroscience Center, Brigham Young University, Provo, Utah
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Linda Ewing-Cobbs
- Children’s Learning Institute, Department of Pediatrics, University of Texas Health Science Center at Houston
| | - Christopher C. Giza
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
- Division of Neurology, Department of Pediatrics, Mattel Children’s Hospital University of California, Los Angeles
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles
| | - Naomi J. Goodrich-Hunsaker
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Cooper B. Hodges
- Department of Psychology, Brigham Young University, Provo, Utah
- School of Social and Behavioral Sciences, Andrews University, Berrien Springs, Michigan
| | - Kristen R. Hoskinson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Marsh Königs
- Emma Neuroscience Group, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey E. Max
- Department of Psychiatry, University of California, San Diego, La Jolla
- Department of Psychiatry, Rady Children’s Hospital, San Diego, California
| | - Mary R. Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD-Norwegian Centre for Headache Research, Trondheim, Norway
| | - Nicholas P. Ryan
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Department of Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam T. Schmidt
- Department of Psychological Sciences, Texas Tech University, Lubbock
| | - Dan J. Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Cape Town University, Cape Town, South Africa
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Neuroscience Institute, Cape Town University, Cape Town, South Africa
| | - Stacy J. Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley L. Ware
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- Department of Psychology, Georgia State University, Atlanta
| | - Anne L. Wheeler
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Physiology Department, University of Toronto, Toronto, Ontario, Canada
| | - Brandon A. Zielinski
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- Department of Pediatrics, University of Florida, Gainesville
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
- Department of Neurology, University of Florida, Gainesville
| | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey
- Department of Neurology, University of Southern California, Los Angeles
- Department of Pediatrics, University of Southern California, Los Angeles
- Department of Psychiatry, University of Southern California, Los Angeles
- Department of Radiology, University of Southern California, Los Angeles
- Department of Engineering, University of Southern California, Los Angeles
- Department of Ophthalmology, University of Southern California, Los Angeles
| | - Ian H. Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - David F. Tate
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Elisabeth A. Wilde
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Emily L. Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
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9
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Lundine JP, Huling JD, Adelson PD, Burd RS, Fuentes M, Haarbauer-Krupa J, Hagen K, Iske C, Koterba C, Kurowski BG, Petrucci S, Rose SC, Sadowsky CL, Westendorf J, Truelove A, Leonard JC. Using Billing Codes to Create a Pediatric Functional Status e-Score for Children Receiving Inpatient Rehabilitation. Arch Phys Med Rehabil 2023; 104:1882-1891. [PMID: 37075966 PMCID: PMC10579455 DOI: 10.1016/j.apmr.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/15/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Provide proof-of-concept for development of a Pediatric Functional Status eScore (PFSeS). Demonstrate that expert clinicians rank billing codes as relevant to patient functional status and identify the domains that codes inform in a way that reliably matches analytical modeling. DESIGN Retrospective chart review, modified Delphi, and nominal group techniques. SETTING Large, urban, quaternary care children's hospital in the Midwestern United States. PARTICIPANTS Data from 1955 unique patients and 2029 hospital admissions (2000-2020); 12 expert consultants representing the continuum of rehabilitation care reviewed 2893 codes (procedural, diagnostic, pharmaceutical, durable medical equipment). MAIN OUTCOME MEASURES Consensus voting to determine whether codes were associated with functional status at discharge and, if so, what domains they informed (self-care, mobility, cognition/ communication). RESULTS The top 250 and 500 codes identified by statistical modeling were mostly composed of codes selected by the consultant panel (78%-80% of the top 250 and 71%-78% of the top 500). The results provide evidence that clinical experts' selection of functionally meaningful codes corresponds with codes selected by statistical modeling as most strongly associated with WeeFIM domain scores. The top 5 codes most strongly related to functional independence ratings from a domain-specific assessment indicate clinically sensible relationships, further supporting the use of billing data in modeling to create a PFSeS. CONCLUSIONS Development of a PFSeS that is predicated on billing data would improve researchers' ability to assess the functional status of children who receive inpatient rehabilitation care for a neurologic injury or illness. An expert clinician panel, representing the spectrum of medical and rehabilitative care, indicated that proposed statistical modeling identifies relevant codes mapped to 3 important domains: self-care, mobility, and cognition/communication.
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Affiliation(s)
- Jennifer P Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH; Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH.
| | - Jared D Huling
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - P David Adelson
- Rockefeller Neuroscience Institute and West Virginia, University Medicine Children's Neuroscience Center, Morgantown, WV
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Molly Fuentes
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Kaitlin Hagen
- International Center for Spinal Cord Injury, Kennedy Krieger Institute and Johns Hopkins School of Medicine, Baltimore, MD
| | - Cynthia Iske
- Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | - Christine Koterba
- Division of Pediatric Psychology and Neuropsychology, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH
| | - Brad G Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stephanie Petrucci
- Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | - Sean C Rose
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | - Cristina L Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute and Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer Westendorf
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Annie Truelove
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Julie C Leonard
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH
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10
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Engin R, Marangoz AH, Tomakin F, Çokluk C. Bilateral Frontoparietotemporal Craniectomy for Traumatic Brain Injury: A Case Report. Cureus 2023; 15:e49410. [PMID: 38149164 PMCID: PMC10750130 DOI: 10.7759/cureus.49410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
There is no conclusive agreement on the optimal approach to managing severe traumatic brain injury. This article details the methodology and outcomes of bilateral frontoparietotemporal decompression surgery performed on a three-year-old patient with severe traumatic brain injury. As the patient had fixed dilated pupils, GCS (Glasgow coma scale) 4, and marked edema in the frontal and parietal regions, the Kjellberg approach was modified, and decompression including part of the parietal bone was performed. The patient was intubated and sedated in the intensive care unit for one week postoperatively. After extubation, the patient had reactive pupils and a GCS of 13. The patient underwent a cranioplasty two months after the trauma, combining the bone grafts placed in the abdomen. The patient was followed for three days after cranioplasty and discharged with a GCS:15 and intact motor examination.
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Affiliation(s)
- Recai Engin
- Department of Neurosurgery, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, TUR
| | | | - Fatih Tomakin
- Department of Neurological Surgery, Unye State Hospital, Ordu, TUR
| | - Cengiz Çokluk
- Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, TUR
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11
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McAvoy M, Hopper RA, Lee A, Ellenbogen RG, Susarla SM. Pediatric Cranial Vault and Skull Base Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:597-606. [PMID: 37442667 DOI: 10.1016/j.coms.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Cranial vault and skull base fractures in children are distinctly different from those seen in adults. Pediatric skull fractures have the benefit of greater capacity to remodel; however, the developing pediatric brain and craniofacial skeleton present unique challenges to diagnosis, natural history, and management. This article discusses the role of surgical treatment of these fractures, its indications, and techniques.
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Affiliation(s)
- Malia McAvoy
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Richard A Hopper
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Amy Lee
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Richard G Ellenbogen
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Srinivas M Susarla
- Department of Neurosurgery; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.
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12
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Panchenko PE, Hippauf L, Konsman JP, Badaut J. Do astrocytes act as immune cells after pediatric TBI? Neurobiol Dis 2023; 185:106231. [PMID: 37468048 PMCID: PMC10530000 DOI: 10.1016/j.nbd.2023.106231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/28/2023] [Accepted: 07/15/2023] [Indexed: 07/21/2023] Open
Abstract
Astrocytes are in contact with the vasculature, neurons, oligodendrocytes and microglia, forming a local network with various functions critical for brain homeostasis. One of the primary responders to brain injury are astrocytes as they detect neuronal and vascular damage, change their phenotype with morphological, proteomic and transcriptomic transformations for an adaptive response. The role of astrocytic responses in brain dysfunction is not fully elucidated in adult, and even less described in the developing brain. Children are vulnerable to traumatic brain injury (TBI), which represents a leading cause of death and disability in the pediatric population. Pediatric brain trauma, even with mild severity, can lead to long-term health complications, such as cognitive impairments, emotional disorders and social dysfunction later in life. To date, the underlying pathophysiology is still not fully understood. In this review, we focus on the astrocytic response in pediatric TBI and propose a potential immune role of the astrocyte in response to trauma. We discuss the contribution of astrocytes in the local inflammatory cascades and secretion of various immunomodulatory factors involved in the recruitment of local microglial cells and peripheral immune cells through cerebral blood vessels. Taken together, we propose that early changes in the astrocytic phenotype can alter normal development of the brain, with long-term consequences on neurological outcomes, as described in preclinical models and patients.
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Affiliation(s)
| | - Lea Hippauf
- CNRS UMR 5536 RMSB-University of Bordeaux, Bordeaux, France
| | | | - Jerome Badaut
- CNRS UMR 5536 RMSB-University of Bordeaux, Bordeaux, France; Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA.
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13
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Faulkner MB, Rizk M, Bazzi Z, Dysko RC, Zhang Z. Sex-Specific Effects of Buprenorphine on Endoplasmic Reticulum Stress, Abnormal Protein Accumulation, and Cell Loss After Pediatric Mild Traumatic Brain Injury in Mice. Neurotrauma Rep 2023; 4:573-585. [PMID: 37752926 PMCID: PMC10518695 DOI: 10.1089/neur.2023.0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Traumatic brain injury (TBI) in children often leads to poor developmental outcomes attributable to progressive cell loss caused by secondary injuries, including endoplasmic reticulum (ER) stress. Buprenorphine (BPN) is commonly used in children for pain management; however, the effects of BPN on ER stress in the pediatric population are still inconclusive. This study investigated the sex-specific effects of BPN on ER stress, abnormal protein accumulation, and cell loss in a mouse impact acceleration model of pediatric TBI. On post-natal day 20-21 (P20-21), male and female littermates were randomized into sham, TBI + saline and TBI + BPN groups. BPN (0.075 mg/kg) was administered to TBI + BPN mice at 30 min after injury and then every 6-12 h for 2 days. The impact of BPN was evaluated at 1, 3, and 7 days post-injury. We found that TBI induced more prominent ER stress pathway activation at 1 and 3 days post-injury in males, compared to females, whereas abnormal protein accumulation and cell loss were more severe in females at 7 days post-injury, compared with males. Although BPN partially ameliorated abnormal protein accumulation and cell loss in both males and females, BPN only decreased ER stress pathway activation in males, not in females. In conclusion, BPN exhibits sex-specific effects on ER stress, abnormal protein accumulation, and cell loss in a time-dependent manner at the acute phase after pediatric TBI, which provides the rationale to assess the potential effects of BPN on long-term outcomes after pediatric TBI in both males and females.
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Affiliation(s)
- Megan B. Faulkner
- Department of Natural Sciences, University of Michigan–Dearborn, Dearborn, Michigan, USA
| | - Mariam Rizk
- Department of Natural Sciences, University of Michigan–Dearborn, Dearborn, Michigan, USA
| | - Zahraa Bazzi
- Department of Natural Sciences, University of Michigan–Dearborn, Dearborn, Michigan, USA
| | - Robert C. Dysko
- Unit for Laboratory Animal Medicine, University of Michigan–Ann Arbor, Ann Arbor, Michigan, USA
| | - Zhi Zhang
- Department of Natural Sciences, University of Michigan–Dearborn, Dearborn, Michigan, USA
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14
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Philipson EB, Machamer J, Dikmen S, Temkin N. Traumatic Brain Injuries Impact on School One Month and One Year After Injury. Neurotrauma Rep 2023; 4:507-514. [PMID: 37771425 PMCID: PMC10523406 DOI: 10.1089/neur.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability among the American population, but the impact TBIs have on the school experience of high school, and post-secondary students, is poorly understood. In this study, a cohort of 79 students, ages 15-22, with mild-to-severe TBIs, were retrospectively identified from the University of Washington Traumatic Brain Injury Database and Sample Repository. The Sickness Impact Profile (SIP) was used to determine the frequency at which schooling was impacted by a TBI and identify the most common self-reported issues students faced in their return to school. At 1 month post-injury, 70% of students either had not returned to school as a result of their TBI or had returned to school but experienced issues related to their TBI. The most-reported issues at 1 month were a difficulty keeping up with school work as a result of it taking longer to complete assignments, tiring easily, having to take frequent rests, and grades that were not as good as they used to be. At 1 year post-injury, the number of students whose TBIs were affecting their school situation dropped 20 percentage points to 49%. The most reported issues at 1 year were forgetting more quickly what was learned in class and having more difficulty understanding new concepts and material. These findings indicate that TBIs have a profound effect on a student's school experiences up to at least 1 year post-injury.
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Affiliation(s)
- Erik B. Philipson
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Joan Machamer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
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15
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Huling JD, Lundine JP, Leonard JC. Doubly structured sparsity for grouped multivariate responses with application to functional outcome score modeling. Stat Med 2023; 42:2619-2636. [PMID: 37032418 PMCID: PMC10535367 DOI: 10.1002/sim.9740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/24/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
This work is motivated by the need to accurately model a vector of responses related to pediatric functional status using administrative health data from inpatient rehabilitation visits. The components of the responses have known and structured interrelationships. To make use of these relationships in modeling, we develop a two-pronged regularization approach to borrow information across the responses. The first component of our approach encourages joint selection of the effects of each variable across possibly overlapping groups of related responses and the second component encourages shrinkage of effects towards each other for related responses. As the responses in our motivating study are not normally-distributed, our approach does not rely on an assumption of multivariate normality of the responses. We show that with an adaptive version of our penalty, our approach results in the same asymptotic distribution of estimates as if we had known in advance which variables have non-zero effects and which variables have the same effects across some outcomes. We demonstrate the performance of our method in extensive numerical studies and in an application in the prediction of functional status of pediatric patients using administrative health data in a population of children with neurological injury or illness at a large children's hospital.
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Affiliation(s)
- Jared D. Huling
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jennifer P. Lundine
- Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio, USA
- Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Julie C. Leonard
- Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, USA
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16
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de Souza LC, Mazzu-Nascimento T, de Almeida Ballestero JG, de Oliveira RS, Ballestero M. Epidemiological study of paediatric traumatic brain injury in Brazil. World Neurosurg X 2023; 19:100206. [PMID: 37181581 PMCID: PMC10172740 DOI: 10.1016/j.wnsx.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/19/2023] [Indexed: 05/16/2023] Open
Abstract
Background Traumatic brain injury (TBI) has a high economic and social impact on the family dynamics, particularly among children. High-quality and comprehensive epidemiological studies about TBI in this population are limited worldwide, specifically in Latin America. Therefore, this study aimed to elucidate the epidemiology of TBI among children in Brazil and its effects on the public health system. Methods This epidemiological (cohort) retrospective study collected data from the Brazilian healthcare database between 1992 and 2021. Results The mean annual volume of hospital admission (HA) due to TBI in Brazil was 29,017. Moreover, the incidence of TBI in the paediatric population was 45.35 admissions per 100,000 inhabitants/year. Furthermore, approximately 941 paediatric hospital deaths per year were caused by TBI, with an in-hospital lethality rate of 3.21%. The average annual financial transfer for TBI was 12,376,628 USD, and the mean cost per admission was 417 USD. In addition, the mean length of hospital stay was 4.2 days. Notably, the length of stay in the hospital was longer among males, Afro-Brazilians patients and individuals aged 15-19 years. Conclusion Paediatric TBI is an important public health issue worldwide with high social and economic costs. The incidence of paediatric TBI in Brazil is similar to that in developing countries. Moreover, male predominance (2.3:1) was observed in relation paediatric TBI. Notably, during the pandemic, the incidence of paediatric HA has decreased. To the best of our knowledge, this is the first epidemiological study that specifically evaluates paediatric TBI in Latin America.
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Affiliation(s)
| | | | | | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Matheus Ballestero
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil
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17
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Yue JK, Krishnan N, Andrews JP, Semonche AM, Deng H, Aabedi AA, Wang AS, Caldwell DJ, Park C, Hirschhorn M, Ghoussaini KT, Oh T, Sun PP. Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective. J Clin Med 2023; 12:jcm12093309. [PMID: 37176749 PMCID: PMC10179657 DOI: 10.3390/jcm12093309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Mild traumatic brain injury (MTBI) causes morbidity and disability worldwide. Pediatric patients are uniquely vulnerable due to developmental and psychosocial factors. Reduced healthcare access in rural/underserved communities impair management and outcome. A knowledge update relevant to current gaps in care is critically needed to develop targeted solutions. METHODS The National Library of Medicine PubMed database was queried using comprehensive search terms (("mild traumatic brain injury" or "concussion") and ("rural" or "low-income" or "underserved") and ("pediatric" or "child/children")) in the title, abstract, and Medical Subject Headings through December 2022. Fifteen articles on rural/underserved pediatric MTBI/concussion not covered in prior reviews were examined and organized into four topical categories: epidemiology, care practices, socioeconomic factors, and telehealth. RESULTS Incidences are higher for Individuals in rural regions, minorities, and those aged 0-4 years compared to their counterparts, and are increasing over time. Rural healthcare utilization rates generally exceed urban rates, and favor emergency departments (vs. primary care) for initial injury assessment. Management guidelines require customization to resource-constrained settings for implementation and adoption. Decreased community recognition of the seriousness of injury is a consensus challenge to care provision by clinicians. Low parental education and income were correlated with decreased MTBI knowledge and worse outcome. Telehealth protocols for triage/consultation and rehabilitation were feasible in improving care delivery to rural and remote settings. CONCLUSIONS Pediatric MTBI/concussion patients in rural/underserved regions experience increased risks of injury, geographic and financial healthcare barriers, and poorer outcomes. Globally, under-reporting of injury has hindered epidemiological understanding. Ongoing MTBI education should be implemented for rural caregivers, schools, and low-income populations to improve community awareness. Telehealth can improve care delivery across acuity settings, and warrants judicious inclusion in triage and treatment protocols.
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Affiliation(s)
- John K Yue
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Nishanth Krishnan
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - John P Andrews
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Alexa M Semonche
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Alexander A Aabedi
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Albert S Wang
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - David J Caldwell
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Christine Park
- Department of Neurosurgery, Duke University, Durham, NC 27708, USA
| | - Melessa Hirschhorn
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kristen T Ghoussaini
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Taemin Oh
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Peter P Sun
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
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18
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Ichimiya Y, Chong PF, Sonoda Y, Tocan V, Watanabe M, Torisu H, Kira R, Takahashi T, Kira JI, Isobe N, Sakai Y, Ohga S. Long-lasting pain and somatosensory disturbances in children with myelin oligodendrocyte glycoprotein antibody-associated disease. Eur J Pediatr 2023:10.1007/s00431-023-04989-z. [PMID: 37119299 DOI: 10.1007/s00431-023-04989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) is an autoantibody associated with acquired demyelinating syndrome (ADS) in childhood and adults. The pathogenic roles of MOG-Ab and long-term outcomes of children with MOG-Ab-associated disease (MOGAD) remain elusive. We investigated the clinical features of children with ADS during follow-up in our institute. Clinical data were retrospectively analyzed using medical charts of patients managed in Kyushu University Hospital from January 1st, 2001, to March 31st, 2022. Participants were children of < 18 years of age when they received a diagnosis of ADS in our hospital. Cell-based assays were used to detect MOG-Ab in serum or cerebrospinal fluid at the onset or recurrence of ADS. The clinical and neuroimaging data of MOG-Ab-positive and MOG-Ab-negative patients were statistically analyzed. Among 31 patients enrolled in this study, 22 (13 females, 59%) received tests for MOG antibodies. Thirteen cases (59%) were MOG-Ab-positive and were therefore defined as MOGAD; 9 (41%) were MOG-Ab-negative. There were no differences between MOGAD and MOG-Ab-negative patients in age at onset, sex, diagnostic subcategories, or duration of follow-up. MOGAD patients experienced headache and/or somatosensory symptoms more frequently than MOG-Ab-negative patients (12/13 (92%) vs. 3/9 (22%); p = 0.0066). Somatosensory problems included persistent pain with hyperesthesia in the left toe, perineal dysesthesia, and facial hypesthesia. No specific neuroimaging findings were associated with MOGAD or the presence of somatosensory symptoms. CONCLUSIONS Long-lasting somatosensory disturbances are prominent comorbidities in children with MOGAD. Prospective cohorts are required to identify molecular and immunogenetic profiles associated with somatosensory problems in MOGAD. WHAT IS KNOWN • Recurrence of demyelinating events occurs in a group of children with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). WHAT IS NEW • Long-lasting headache and somatosensory problems are frequent comorbidities with pediatric MOGAD. Pain and somatosensory problems may persist for more than 5 years. • Neuroimaging data do not indicate specific findings in children with somatic disturbances.
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Affiliation(s)
- Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Torisu
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurology, National Hospital Organization, Yonezawa National Hospital, Yonezawa, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
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19
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Crook L, Riccardi JS, Ruddock HS, Ciccia A. Speech-Language Pathology Treatment of Cognitive-Communication Deficits in School-Aged Children With Traumatic Brain Injury: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1826-1841. [PMID: 37116307 DOI: 10.1044/2023_jslhr-22-00417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE The purpose of this scoping review was to synthesize the current evidence-based treatment practices used with school-aged children with any severity of traumatic brain injury (TBI) that could benefit the practice of speech-language pathologists (SLPs). METHOD A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Included studies were assigned thematic labels based on a modified version of the Rehabilitation Treatment Specification System. RESULTS A total of 27 articles that covered 16 different treatment approaches met inclusion criteria for this study. Most studies included adolescent or teenage participants with moderate-severe TBIs. Treatment targets included executive functioning (n = 15), social competence (n = 6), postconcussive symptoms (n = 5), behavior (n = 3), family functioning (n = 1), and health-related quality of life (n = 1). The majority of current interventions for school-aged children with TBI include a multidisciplinary approach and components of family involvement education. CONCLUSIONS Further research is needed on interventions that are specifically implemented by SLPs as well as protocols that include more heterogeneous samples (e.g., varied sociodemographic factors and injury severity) to allow for the development and testing of ecologically valid intervention practice. SLPs can use the results of this scoping review to individualize treatment based on the child's areas of need while considering individual characteristics and to provide person-centered intervention for children with school-aged TBI.
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Affiliation(s)
- Libby Crook
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Jessica S Riccardi
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Hannah S Ruddock
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Angela Ciccia
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
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20
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Lindsay S, Patel S, Ragunathan S, Fuentes K. Ableism among children and youth with acquired brain injury and their caregivers: a systematic review. Brain Inj 2023:1-12. [PMID: 36856419 DOI: 10.1080/02699052.2023.2184869] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
PURPOSE Children and youth with acquired brain injury (ABI) experience persistent discrimination and ableism. The purpose of this systematic review was to understand the experiences and impact of ableism among children and youth with ABI. METHOD Six international databases were systematically searched for articles from 2002-2022. Studies were screened independently by four researchers who performed the data extraction. Study quality was appraised using the Standard quality assessment criteria for evaluating primary research. RESULTS Of the 2085 studies identified in the search, 15 met the inclusion criteria, which involved 1442 children and youth with brain injuries or caregivers representing them. Studies in the review showed the following key trends: (1) incidence of ableism among children and youth with ABI; (2) experiences of ableism at the individual and institutional levels, (3) impact of ableism (i.e., mental health, social relationships, quality of life) and (4) coping strategies (i.e., resources, supports). CONCLUSIONS Our findings reveal the alarming incidence of ableism among youth with ABI. Therefore, there is a critical need for more research to explore youth's lived experiences of ableism, especially from their perspectives along with the co-development of solutions to help enhance their social inclusion and well-being.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Stuti Patel
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Psychology, University of Toronto Mississauga, Mississauga, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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21
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Balogun JA, Koko AM, Adebayo A, Aniaku I, Lasseini A, Balogun FM, Uche EO. Fall-related traumatic brain injury in a Nigerian pediatric population. J Clin Neurosci 2023; 109:26-31. [PMID: 36642033 DOI: 10.1016/j.jocn.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Accidental falls are a common cause of disability and trauma-related death in the pediatric population, accounting for a large number of pediatric emergency hospital admissions. This multicenter study assesses the clinical characteristics, management outcomes of pediatric falls-related traumatic brain injury and associated factors in Nigeria. METHODS A retrospective study of pediatric patients (age less than 18-years) with falls over a 2-year period. Data was extracted from clinical records and neurosurgical data sheets from three major centres in Nigeria, and was analyzed using descriptive statistics, Chi square test and multinomial regression with significance set at p < 0.05. RESULTS 128 children presented with fall-related TBI, with a median age of 96 months (age range of 5-216 months) and M:F was 6:1. 40.6 % had moderate head injury and 55.5 % of the falls were building related. There were 52(42.6 %) children with skull fractures. Older children more commonly fell from trees and had more cases of severe head injury (14.1 %) compared with those who fell from buildings (5.5 %). Children who fell from buildings presented early (64.1 %). The 10 % mortality was mainly in children older than 5-years. Children aged 0-5 years were three times likely to fall inside/outside a building (OR: 3.3, CI: 3.06 to 243.44). Also, those who fell from trees were 6 times more likely to have a long bone fracture (OR: 6.1, CI: 1.2 to 32.6). CONCLUSIONS In the Nigerian population Traumatic Brain Injury from falls is common among children, with older children falling more from trees and associated with high mortality.
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Affiliation(s)
- James A Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Nigeria; Department of Neurosurgery, University College Hospital, Ibadan, Nigeria.
| | - Aliyu M Koko
- Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University, Teaching Hospital, Nigeria
| | - Adegboyega Adebayo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Ikechukwu Aniaku
- Neurosurgery Unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Ali Lasseini
- Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University, Teaching Hospital, Nigeria
| | - Folusho M Balogun
- Adolescent Health Unit, Institute of Child Health, College of Medicine University of Ibadan, Nigeria
| | - Enoch O Uche
- Adolescent Health Unit, Institute of Child Health, College of Medicine University of Ibadan, Nigeria
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22
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Gerber N, Munnangi S, Vengalasetti Y, Gupta S. Trauma center variation of head computed tomography utilization in children presenting with mild traumatic brain injury. Clin Imaging 2023; 94:125-131. [PMID: 36529077 DOI: 10.1016/j.clinimag.2022.11.024] [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: 04/28/2022] [Revised: 10/16/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although published clinical decision rules have identified indications for the use of head CT in children with mild traumatic brain injury, practices vary. OBJECTIVE This study seeks to evaluate whether the utilization of head CT in pediatric trauma patients presenting with mTBI varies between American College of Surgeons verified pediatric trauma centers (ACS-PTC) and adult-only trauma centers (ACS-AOTC). MATERIAL AND METHODS A retrospective cohort study of 24,104 trauma patients, ≤17, who presented to the emergency department at 337 ACS verified level I/II trauma centers with isolated mTBI was conducted using National Trauma Data Bank records (2011-2015). Multivariable logistic regression was used to compare the odds of a patient receiving a head CT when treated at an ACS-PTC vs. an ACS-AOTC, controlling for demographic, injury, and hospital-level confounders. Effect modification by loss of consciousness was assessed and adjusted head CT odds were recalculated in patients stratified by LOC status. RESULTS There was no significant difference in the adjusted odds of receiving a head CT at an ACS-PTC vs. an ACS-AOTC (odds ratio: 0.98, 95% confidence interval: 0.92-1.04). However, in patients who had a LOC, the adjusted OR of receiving a head CT at an ACS-PTC vs ACS-AOTC was 0.71 (95% confidence interval: 0.65-0.78). CONCLUSION Children presenting to the emergency department of an ACS-verified level I or II trauma center with mTBI who had a loss of consciousness are less likely to receive a head CT at an ACS verified pediatric trauma center than at an ACS verified adult-only trauma center.
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Affiliation(s)
- Noam Gerber
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, United States of America.
| | - Swapna Munnangi
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, United States of America
| | - Yasaswi Vengalasetti
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Sameer Gupta
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, United States of America
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23
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Kuitunen I, Ponkilainen VT, Iverson GL, Isokuortti H, Luoto TM, Mattila VM. Increasing incidence of pediatric mild traumatic brain injury in Finland - a nationwide register study from 1998 to 2018. Injury 2023; 54:540-546. [PMID: 36564327 DOI: 10.1016/j.injury.2022.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
AIM The purpose of this study is to document the annual incidence and incidence trends of pediatric traumatic brain injury (pTBI) in Finland over the course of 21 years. METHODS We conducted a retrospective nationwide register-based cohort study and used the Finnish Care Register and Population information statistics from 1998 to 2018. The patient group includes all patients aged <18 at the time of injury. We included all emergency department (ED) visits and subsequent inpatient admissions (meaning at least one night in the hospital) with International Classification of Diseases diagnostic code S06*. We calculated pTBI incidences per 100,000 person-years with 95% confidence intervals and the incidences were compared by incidence rate ratios (IRR), including age, diagnosis, and gender stratified analyses. RESULTS A total of 71,972 patients were included with 76,785 ED visits or hospitalizations for pTBI diagnoses. The annual incidence of diagnosed pTBI was 251 (CI: 241-260) per 100,000 in 1998 and 547 (CI: 533-561) per 100,000 in 2018, indicating a 118% increase in the incidence (IRR 2.18 CI: 2.09-2.28). Boys had 32% higher incidence (IRR 1.32 CI: 1.30-1.34) than girls. The highest cumulative incidence was observed among boys aged <1 years, 525 (CI: 507-543) per 100,000, and boys had higher incidences in all age groups. The most used diagnostic code was concussion, which included 92.1% of the diagnoses followed by diffuse brain injury, which included 2.3% of the diagnoses. The increase in the incidence of diagnosed pTBI was notably high after 2010. Concussion diagnoses and pTBI cases that were discharged directly from the ED had more than a two-fold increase from 2010 to 2018, whereas the incidence of inpatient admissions for pTBI increased by 53%. CONCLUSIONS The overall incidence of diagnosed pTBI has increased in Finland especially since 2010. Boys have higher incidence of diagnosed pTBI in all age groups. Most of the increase was due to increase in the concussion diagnoses, which may be due to the centralization of EDs into bigger units and increased diagnostic awareness of mild pTBI.
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Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.
| | | | - Grant L Iverson
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, United States of America; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts, United States of America
| | - Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
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24
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The need for blood transfusion therapy is associated with increased mortality in children with traumatic brain injury. PLoS One 2023; 18:e0279709. [PMID: 36607845 PMCID: PMC9821419 DOI: 10.1371/journal.pone.0279709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Blood transfusion therapy (BTT) is widely used in trauma patients. However, the adverse effects of BTT in pediatric trauma patients with traumatic brain injury (TBI) were poorly studied. The objective of this study is to evaluate the effect of BTT on mortality in children with severe TBI. METHODS In this retrospective cohort analysis, we analyzed 2012 and 2016 Kids' Inpatient Databases and used a weighted sample to obtain national outcome estimates. We included children aged 1 month to 21 years with TBI who were mechanically ventilated, considered severe TBI; we then compared the demographics, comorbidities, and mortality rates of those patients who had undergone BTT to those who did not. Statistical analysis was performed using the chi-squared test and regression models. In addition, in a correlative propensity score matched analysis, cases (BTT) were matched 1:1 with controls (non-BTT) based on age, gender, hospital region, income quartiles, race, and All Patients Refined Diagnosis Related Groups (APRDRG) severity of illness scores to minimize the effect of confounding variables between the groups. RESULTS Out of 87,980 children with a diagnosis of TBI, 17,199 (19.5%) with severe TBI were included in the analysis. BTT was documented in 3184 (18.5%) children. Among BTT group, the mortality was higher compared to non-BTT group [31.6% (29.7-33.5%) vs. 14.4 (13.7-15.1%), (OR 2.2, 95% CI 1.9-2.6; p<0.05)]. In the BTT group, infants and adolescents, white race, APRDRG severity of illness, cardiac arrest, platelet, and coagulation factor transfusions were associated with higher mortality. In a propensity-matched analysis, BTT associated with a higher risk of mortality (32.1% [30.1-34.2] vs. 17.4% [15.8-19.1], p<0.05; OR: 2.2, 95% CI: 1.9-2.6). CONCLUSION In children with severe TBI, blood transfusion therapy is associated with higher mortality.
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25
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Multiple Head Rotations Result in Persistent Gait Alterations in Piglets. Biomedicines 2022; 10:biomedicines10112976. [PMID: 36428544 PMCID: PMC9687234 DOI: 10.3390/biomedicines10112976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Multiple/repeated mild traumatic brain injury (mTBI) in young children can cause long-term gait impairments and affect the developmental course of motor control. Using our swine model for mTBI in young children, our aim was to (i) establish a reference range (RR) for each parameter to validate injury and track recovery, and (ii) evaluate changes in gait patterns following a single and multiple (5×) sagittal rapid non-impact head rotation (RNR). Gait patterns were studied in four groups of 4-week-old Yorkshire swine: healthy (n = 18), anesthesia-only sham (n = 8), single RNR injury (n = 12) and multiple RNR injury (n = 11). Results were evaluated pre-injury and at 1, 4, and 7 days post-injury. RR reliability was validated using additional healthy animals (n = 6). Repeated mTBI produced significant increases in gait time, cycle time, and stance time, as well as decreases in gait velocity and cadence, on Day One post-injury compared to pre-injury, and these remained significantly altered at Day Four and Day Seven post-injury. The gait metrics of the repeated TBI group also significantly fell outside the healthy RR on Day One, with some recovery by Day Four, while many remained altered at Day Seven. Only a bilateral decrease in hind stride length was observed at Day Four in our single RNR group compared to pre-injury. In sum, repeated and single sagittal TBI can significantly impair motor performance, and gait metrics can serve as reliable, objective, quantitative functional assessments in a juvenile porcine RNR TBI model.
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Pakyurek M, Badawy M, Ugalde IT, Ishimine P, Chaudhari PP, McCarten-Gibbs K, Nobari O, Kuppermann N, Holmes JF. Does attention-deficit/hyperactivity disorder increase the risk of minor blunt head trauma in children? JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 35:356-361. [PMID: 35962779 PMCID: PMC9637762 DOI: 10.1111/jcap.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/07/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
PROBLEM It is unclear if attention-deficit hyperactivity disorder (ADHD) increases the risk of head trauma in children. METHODS We conducted a multicenter prospective observational study of children with minor blunt head trauma. Guardians were queried, and medical records were reviewed as to whether the patient had previously been diagnosed with ADHD. Enrolled patients were categorized based on their mechanism of injury, with a comparison of those with motor vehicle collision (MVC) versus non-MVC mechanisms. FINDINGS A total of 3410 (84%) enrolled children had ADHD status available, and 274 (8.0%; 95% confidence interval, CI: 7.1, 9.0%) had been diagnosed with ADHD. The mean age was 9.2 ± 3.5 years and 64% were males. Rates of ADHD for specific mechanisms of injury were: assaults: 23/131 (17.6%; 95% CI 11.5, 25.2%), automobile versus pedestrian 23/173 (13.3%; 95% CI: 8.6, 19.3%), bicycle crashes 26/148 (17.6%; 95% CI: 11.8, 24.7%), falls 107/1651 (6.5%; 95% 5.3, 7.8%), object struck head 31/421 (7.4%; 5.1, 10.3%), motorized vehicle crashes (e.g., motorcycle, motor scooter) 11/148 (7.4%; 3.8, 12.9%), and MVCs 46/704 (6.5%; 95% CI: 4.8, 8.6%). CONCLUSION Children with ADHD appear to be at increased risk of head trauma from certain mechanisms of injury including assaults, auto versus pedestrian, and bicycle crashes but are not at an increased risk for falls.
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Affiliation(s)
- Murat Pakyurek
- Department of Psychiatry and Behavioral Sciences, School of Medicine, UC Davis, Sacramento, California, USA
| | - Mohamed Badawy
- Department of Pediatrics, UT Southwestern, Dallas, Texas, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Paul Ishimine
- Department of Emergency Medicine and Pediatrics, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Kevan McCarten-Gibbs
- Department of Emergency Medicine, UCSF Benioff Children's Hospital, Oakland, California, USA
| | - Ozra Nobari
- Department of Psychiatry and Behavioral Sciences, School of Medicine, UC Davis, Sacramento, California, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine and Pediatrics, School of Medicine, UC Davis, Sacramento, California, USA
| | - James F Holmes
- Department of Emergency Medicine, School of Medicine, UC Davis, Sacramento, California, USA
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27
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Mariajoseph FP, Chen Z, Sekhar P, Rewell SS, O'Brien TJ, Antonic‐Baker A, Semple BD. Incidence and risk factors of posttraumatic epilepsy following pediatric traumatic brain injury: A systematic review and meta-analysis. Epilepsia 2022; 63:2802-2812. [PMID: 35996866 PMCID: PMC9826023 DOI: 10.1111/epi.17398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/31/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
Posttraumatic epilepsy (PTE) is a well-known chronic complication following traumatic brain injury (TBI). Despite some evidence that age at the time of injury may influence the likelihood of PTE, the incidence of PTE in pediatric populations remains unclear. We therefore conducted a systematic review to determine the overall reported incidence of PTE, and explore potential risk factors associated with PTE after pediatric TBI. A comprehensive literature search of the PubMed, Embase, and Web of Science databases was conducted, including randomized controlled trials and cohort studies assessing the incidence of PTE in TBI pediatric patients. We excluded studies with a sample size of <10 patients and those in which a pediatric cohort was not clearly discernable. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We found that the overall incidence of PTE following pediatric TBI was 10% (95% confidence interval [CI] = 5.9%-15%). Subgroup analysis of a small number of studies demonstrated that the occurrence of early seizures (cumulative incidence ratio [CIR] = 7.28, 95% CI = 1.09-48.4, p = .040), severe TBI (CIR = 1.81, 95% CI = 1.23-2.67, p < .001), and intracranial hemorrhage (CIR = 1.60, 95% CI = 1.06-2.40, p = .024) increased the risk of PTE in this population. Other factors, including male sex and neurosurgical intervention, were nonsignificantly associated with a higher incidence of PTE. In conclusion, PTE is a significant chronic complication following childhood TBI, similar to in the adult population. Further standardized investigation into clinical risk factors and management guidelines is warranted. PROSPERO ID# CRD42021245802.
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Affiliation(s)
| | - Zhibin Chen
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Praba Sekhar
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Sarah S. Rewell
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia
| | - Terence J. O'Brien
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia,Department of Medicine (Royal Melbourne Hospital)University of MelbourneParkvilleVictoriaAustralia
| | - Ana Antonic‐Baker
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Bridgette D. Semple
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia,Department of NeurologyAlfred HealthPrahranVictoriaAustralia,Department of Medicine (Royal Melbourne Hospital)University of MelbourneParkvilleVictoriaAustralia
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28
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Boroojeni PE, Chen Y, Commean PK, Eldeniz C, Skolnick GB, Merrill C, Patel KB, An H. Deep-learning synthesized pseudo-CT for MR high-resolution pediatric cranial bone imaging (MR-HiPCB). Magn Reson Med 2022; 88:2285-2297. [PMID: 35713359 PMCID: PMC9420780 DOI: 10.1002/mrm.29356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE CT is routinely used to detect cranial abnormalities in pediatric patients with head trauma or craniosynostosis. This study aimed to develop a deep learning method to synthesize pseudo-CT (pCT) images for MR high-resolution pediatric cranial bone imaging to eliminating ionizing radiation from CT. METHODS 3D golden-angle stack-of-stars MRI were obtained from 44 pediatric participants. Two patch-based residual UNets were trained using paired MR and CT patches randomly selected from the whole head (NetWH) or in the vicinity of bone, fractures/sutures, or air (NetBA) to synthesize pCT. A third residual UNet was trained to generate a binary brain mask using only MRI. The pCT images from NetWH (pCTNetWH ) in the brain area and NetBA (pCTNetBA ) in the nonbrain area were combined to generate pCTCom . A manual processing method using inverted MR images was also employed for comparison. RESULTS pCTCom (68.01 ± 14.83 HU) had significantly smaller mean absolute errors (MAEs) than pCTNetWH (82.58 ± 16.98 HU, P < 0.0001) and pCTNetBA (91.32 ± 17.2 HU, P < 0.0001) in the whole head. Within cranial bone, the MAE of pCTCom (227.92 ± 46.88 HU) was significantly lower than pCTNetWH (287.85 ± 59.46 HU, P < 0.0001) but similar to pCTNetBA (230.20 ± 46.17 HU). Dice similarity coefficient of the segmented bone was significantly higher in pCTCom (0.90 ± 0.02) than in pCTNetWH (0.86 ± 0.04, P < 0.0001), pCTNetBA (0.88 ± 0.03, P < 0.0001), and inverted MR (0.71 ± 0.09, P < 0.0001). Dice similarity coefficient from pCTCom demonstrated significantly reduced age dependence than inverted MRI. Furthermore, pCTCom provided excellent suture and fracture visibility comparable to CT. CONCLUSION MR high-resolution pediatric cranial bone imaging may facilitate the clinical translation of a radiation-free MR cranial bone imaging method for pediatric patients.
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Affiliation(s)
- Parna Eshraghi Boroojeni
- Dept. of Biomedical Engineering, Washington University in
St. Louis, St. Louis, Missouri 63110, USA
| | - Yasheng Chen
- Dept. of Neurology, Washington University in St. Louis, St.
Louis, Missouri 63110, USA
| | - Paul K. Commean
- Mallinckrodt Institute of Radiology, Washington University
in St. Louis, St. Louis, Missouri 63110, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University
in St. Louis, St. Louis, Missouri 63110, USA
| | - Gary B. Skolnick
- Division of Plastic and Reconstructive Surgery, Washington
University in St. Louis, St. Louis, Missouri 63110, USA
| | - Corinne Merrill
- Division of Plastic and Reconstructive Surgery, Washington
University in St. Louis, St. Louis, Missouri 63110, USA
| | - Kamlesh B. Patel
- Division of Plastic and Reconstructive Surgery, Washington
University in St. Louis, St. Louis, Missouri 63110, USA
| | - Hongyu An
- Dept. of Biomedical Engineering, Washington University in
St. Louis, St. Louis, Missouri 63110, USA
- Dept. of Neurology, Washington University in St. Louis, St.
Louis, Missouri 63110, USA
- Mallinckrodt Institute of Radiology, Washington University
in St. Louis, St. Louis, Missouri 63110, USA
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29
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Pediatric Medical Traumatic Stress in Inflammatory Bowel Disease, Pancreatitis, and Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2022; 75:455-461. [PMID: 35881966 DOI: 10.1097/mpg.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Known as pediatric medical traumatic stress (PMTS), posttraumatic stress symptoms from medical experiences have not been explored in children with chronic gastrointestinal diseases. This cross-sectional study of children and adolescents with inflammatory bowel disease, chronic pancreatitis and cystic fibrosis, aimed to (1) estimate the prevalence of medical potentially traumatic events (PTEs) and PMTS, (2) explore potential risk factors for PMTS, and (3) explore potential consequences of PMTS. METHODS This cross-sectional study used validated, self-report measures to evaluate PTEs and PMTS. Descriptive statistics and regression analyses were used to achieve study objectives. RESULTS Over two-thirds of children reported a medical potentially traumatic event (91 of 132, 69%). Forty-eight had PMTS symptoms (36%). PMTS was associated with medication burden, emergency and intensive care visits, and parent posttraumatic stress disorder in multivariate analysis. Potential consequences associated with PMTS included school absenteeism, home opioid use, poor quality of life, and parent missed work. CONCLUSIONS A substantial portion of our cohort reported medical PTEs and PMTS. The exploratory analysis identified potential associations between PMTS and illness factors, parent posttraumatic stress disorder, and functional impairments. Further studies of PMTS detection, prevention and treatment are integral to optimizing these children's health and quality of life.
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Deshpande SJ, Velonjara J, Lujan S, Petroni G, Wang J, Patel KV, Boyle LN, Bell MJ, Vavilala MS. Provider perceptions of severe pediatric traumatic brain injury care priorities across hospitals in South America before and during the COVID-19 pandemic. PLoS One 2022; 17:e0275255. [PMID: 36174092 PMCID: PMC9522258 DOI: 10.1371/journal.pone.0275255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
To understand provider perceptions of the COVID-19 pandemic on priorities of severe pediatric traumatic brain injury (TBI) care across hospitals in South America.
Methods
Site principal investigators (PIs) from 17 hospitals in South America enrolled in the PEGASUS-Argentina randomized controlled trial completed questionnaires regarding order of tasks performed in the care of a typical pediatric patient with severe TBI before (2019) and during (2021) the COVID-19 pandemic. Acute care processes were examined by quintiles to identify early, mid, and late actions and were categorized and compared. Associations of hospital volume and subspecialty resource availability with prioritization of key process actions were examined.
Finding
Site PIs from 15 and 16 hospitals completed the surveys in 2019 and 2021, respectively, including 14 who completed both. Action category order was stable between 2019 and 2021 and were ranked in priorities as: initial encounter, primary survey, interventions and invasive monitors, diagnostics, medications, staff communication, then disposition (in 2019) or nutrition (in 2021). There was variation in specific action order between hospitals at both timepoints, with only a few initial encounter and disposition actions limited to a single quintile. There was no reported association between hospital volume or subspecialty resource availability with prioritization of key process actions.
Interpretation
Despite novel healthcare challenges presented by the COVID-19 pandemic, providers in South America perceived maintaining standard severe pediatric TBI care consistent with BTF guidelines. There was large variability in specific action order between individual hospitals reported.
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Affiliation(s)
- Shyam J. Deshpande
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
- Harborview Injury Prevention & Research Center, Seattle, WA, United States of America
| | - Julia Velonjara
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States of America
- Harborview Injury Prevention & Research Center, Seattle, WA, United States of America
- * E-mail:
| | - Silvia Lujan
- Centro de Informática e Investigación Clínica, Rosario, Argentina
| | - Gustavo Petroni
- Centro de Informática e Investigación Clínica, Rosario, Argentina
| | - Jin Wang
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
- Harborview Injury Prevention & Research Center, Seattle, WA, United States of America
| | - Kushang V. Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States of America
- Harborview Injury Prevention & Research Center, Seattle, WA, United States of America
| | - Linda Ng Boyle
- Department of Industrial and System Engineering, University of Washington, Seattle, WA, United States of America
| | - Michael J. Bell
- Children’s National Hospital Critical Care Medicine, Washington, DC, United States of America
| | - Monica S. Vavilala
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
- Harborview Injury Prevention & Research Center, Seattle, WA, United States of America
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Reynolds RA, Kelly KA, Ahluwalia R, Zhao S, Vance EH, Lovvorn HN, Hanson H, Shannon CN, Bonfield CM. Protocolized management of isolated linear skull fractures at a level 1 pediatric trauma center. J Neurosurg Pediatr 2022; 30:255-262. [PMID: 35901741 DOI: 10.3171/2022.6.peds227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Isolated linear skull fractures without intracranial findings rarely require urgent neurosurgical intervention. A multidisciplinary fracture management protocol based on antiemetic usage was implemented at our American College of Surgeons-verified level 1 pediatric trauma center on July 1, 2019. This study evaluated protocol safety and efficacy. METHODS Children younger than 18 years with an ICD-10 code for linear skull fracture without acute intracranial abnormality on head CT were compared before and after protocol implementation. The preprotocol cohort was defined as children who presented between July 1, 2015, and December 31, 2017; the postprotocol cohort was defined as those who presented between July 1, 2019, and July 1, 2020. RESULTS The preprotocol and postprotocol cohorts included 162 and 82 children, respectively. Overall, 57% were male, and the median (interquartile range) age was 9.1 (4.8-25.0) months. The cohorts did not differ significantly in terms of sex (p = 0.1) or age (p = 0.8). Falls were the most common mechanism of injury (193 patients [79%]). After protocol implementation, there was a relative increase in patients who fell from a height > 3 feet (10% to 29%, p < 0.001) and those with no reported injury mechanism (12% to 16%, p < 0.001). The neurosurgery department was consulted for 86% and 44% of preprotocol and postprotocol cases, respectively (p < 0.001). Trauma consultations and consultations for abusive head trauma did not significantly change (p = 0.2 and p = 0.1, respectively). Admission rate significantly decreased (52% to 38%, p = 0.04), and the 72-hour emergency department revisit rate trended down but was not statistically significant (2.8/year to 1/year, p = 0.2). No deaths occurred, and no inpatient neurosurgical procedures were performed. CONCLUSIONS Protocolization of isolated linear skull fracture management is safe and feasible at a high-volume level 1 pediatric trauma center. Neurosurgical consultation can be prioritized for select patients. Further investigation into criteria for admission, need for interfacility transfers, and healthcare costs is warranted.
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Affiliation(s)
- Rebecca A Reynolds
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Katherine A Kelly
- 3Department of Neurosurgery, University of Washington, Seattle, Washington
| | - Ranbir Ahluwalia
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Shilin Zhao
- 4Department of Biostatistics, Vanderbilt University Medical Center, Nashville
| | - E Haley Vance
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Harold N Lovvorn
- 5Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville; and
| | - Holly Hanson
- 6Department of Pediatrics, Division of Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Christopher M Bonfield
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Lu VM, Kreuger E, Cordeiro JG, Niazi TN, Jagid JR, McCrea HJ. Clinical complications of surviving gunshot wounds to the head in children and adolescents: the Miami experience. Childs Nerv Syst 2022; 38:1735-1742. [PMID: 35606660 DOI: 10.1007/s00381-022-05558-9] [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: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gunshot wounds (GSWs) to the head in the pediatric population are both rare and devastating, with the clinical course of pediatric survivors poorly understood. Correspondingly, the aim of this study was to summarize the clinical complications clinicians can expect of survivors of GSW to the head in children and adolescents in hospital and after discharge. METHODS A retrospective review of our Level 1 trauma center database between 2011 and 2021 was performed. Clinical data was extracted for those patients aged ≤ 18 years old who survived initial hospitalization with at least one documented follow-up. Categorical data were then compared using Chi-squared test. RESULTS A total of 19 pediatric survivors of GSW to the head satisfied all selection criteria with an average age was 15.3 years. The majority of cases were isolated head injuries (63%), with an average Glasgow Coma Score (GCS) of 11.9. Bullet trajectory was intraparenchymal in 11 (58%) cases and extraparenchymal in 8 (42%) cases, with 15 (79%) patients treated by surgical intervention. A total of 13 (68%) patients experienced a complication during their hospitalization, with the most common being sympathetic hypertension and endocrinologic salt wasting, each occurring in 5 (26%) patients. With respect to complication categories, the intraparenchymal patients experienced statistically more complications than extraparenchymal patients that were infectious (54% vs 0%, P = 0.01) and sympathetic (45% vs 0%, P = 0.03) in nature. However, with respect to overall neurologic (P = 0.24), endocrinologic (P = 0.24), and traumatic (P = 0.24) complications, their incidences were statistically comparable. All patients were successfully discharged on average post-injury day 22 with an average GCS of 14.0. Mean follow-up for the cohort was 42.6 months, with an average GCS of 14.3. A total of 6 (32%) patients experienced a complication relatable to their initial GSW injury after discharge. The most common individual complication was new-onset seizures in 3 (16%) patients. CONCLUSIONS Survivors of pediatric GSW to the head can experience multi-systemic complications during both initial hospitalization and afterwards, and bullet trajectory involving the parenchyma may be associated with specific complications more than others. Dedicated inpatient management and outpatient follow-up involving surveillance for complications across all systems, not just neurological, are recommended to ensure patients receive the best care possible.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.
| | - Evan Kreuger
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Joacir G Cordeiro
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Toba N Niazi
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.,Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA
| | - Jonathan R Jagid
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Heather J McCrea
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA.,Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA
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National characteristics, etiology, and inpatient outcomes of pediatric traumatic brain injury: a KID study. Childs Nerv Syst 2022; 38:1541-1547. [PMID: 35499615 DOI: 10.1007/s00381-022-05544-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) in pediatric patients is a major burden to public health. Understanding clinical associations with severity and short hospitalization (≤ 1 day length of stay) is needed to better inform management paradigms and optimize triage. METHODS A retrospective review of the Kids' Inpatient Database (KID) was performed for all data reported between 2006 and 2012 for TBI patients aged ≤ 20 years. Univariate and multivariate regression analyses were performed to identify predictive factors of trauma severity and short hospitalization. RESULTS A total of 220,777 pediatric TBI cases were identified, with the majority of cases being boys (66%) with a mean age of 11.5 years. Mean length of stay was 5.0 days, with 25% discharged within 1 day, and 83% routinely discharged home. In-hospital mortality occurred in 4% of cases. More severe TBI presentations were significantly and independently associated with older age, weekend admissions, hospital transfers, and in patients with chronic conditions and neurological issues (all P < 0.01). There were 38% of admission that were short hospitalizations. Younger age, male gender, less chronic conditions, fall and assault etiologies, and with milder injury severity all significantly and independently predicted greater likelihood of short hospitalization. CONCLUSIONS The severity of pediatric TBI admissions to the hospital can be impacted by a number of parameters. Furthermore, there exists a subset of clinical associations for short hospitalization admissions. Proactive identification of these parameters at time of presentation will assist in optimizing the management of pediatric TBI].
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Zhang Y, Wang L, Pan Q, Yang X, Cao Y, Yan J, Wang Y, Tao Y, Fan R, Sun X, Li L. Selective sphingosine-1-phosphate receptor 1 modulator attenuates blood-brain barrier disruption following traumatic brain injury by inhibiting vesicular transcytosis. Fluids Barriers CNS 2022; 19:57. [PMID: 35820896 PMCID: PMC9277863 DOI: 10.1186/s12987-022-00356-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) provokes secondary pathological damage, such as damage to the blood-brain barrier (BBB), ischaemia and inflammation. Major facilitator superfamily domain-containing 2a (Mfsd2a) has been demonstrated to be critical in limiting the increase in BBB vesicle transcytosis following brain injury. Recent studies suggest that a novel and selective modulator of the sphingosine-1-phosphate receptor 1 (S1P1), CYM-5442, maintains the integrity of the BBB by restricting vesicle transcytosis during acute ischaemic stroke. In the current study, we investigated whether CYM-5442, evaluated in a short-term study, could protect the brains of mice with acute-stage TBI by reversing the increase in vesicle transport due to reduced Mfsd2a expression after TBI. METHODS We used the well-characterized model of TBI caused by controlled cortical impact. CYM-5442 (0.3, 1, 3 mg/kg) was intraperitoneally injected 30 min after surgery for 7 consecutive days. To investigate the effect of CYM-5442 on vesicle transcytosis, we downregulated and upregulated Mfsd2a expression using a specific AAV prior to evaluation of the TBI model. MRI scanning, cerebral blood flow, circulating blood counts, ELISA, TEM, WB, and immunostaining evaluations were performed after brain injury. RESULTS CYM-5442 significantly attenuated neurological deficits and reduced brain oedema in TBI mice. CYM-5442 transiently suppressed lymphocyte trafficking but did not induce persistent lymphocytopenia. After TBI, the levels of Mfsd2a were decreased significantly, while the levels of CAV-1 and albumin were increased. In addition, Mfsd2a deficiency caused inadequate sphingosine-1-phosphate (S1P) transport in the brain parenchyma, and the regulation of BBB permeability by Mfsd2a after TBI was shown to be related to changes in vesicle transcytosis. Downregulation of Mfsd2a in mice markedly increased the BBB permeability, neurological deficit scores, and brain water contents after TBI. Intervention with CYM-5442 after TBI protected the BBB by significantly reducing the vesicle transcytosis of cerebrovascular endothelial cells. CONCLUSION In addition to transiently suppressing lymphocytes, CYM-5442 alleviated the neurological deficits, cerebral edema and protective BBB permeability in TBI mice by reducing the vesicle transcytosis of cerebrovascular endothelial cells.
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Affiliation(s)
- Yuan Zhang
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Lin Wang
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Qiuling Pan
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaomin Yang
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yunchuan Cao
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jin Yan
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yingwen Wang
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yihao Tao
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Runjin Fan
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Xiaochuan Sun
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Lin Li
- Department of Neurosurgery, Neural Injury and Protection Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Roberts H, Ford TJ, Karl A, Reynolds S, Limond J, Adlam ALR. Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model. Front Hum Neurosci 2022; 16:835897. [PMID: 35754774 PMCID: PMC9218558 DOI: 10.3389/fnhum.2022.835897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose/Objective Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population. Method We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation. Results and Implications We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.
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Affiliation(s)
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Anke Karl
- Psychology, University of Exeter, Exeter, United Kingdom
| | - Shirley Reynolds
- Department of Psychology, University of Reading, Reading, United Kingdom
| | - Jenny Limond
- Psychology, University of Exeter, Exeter, United Kingdom
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Lui A, Kumar KK, Grant GA. Management of Severe Traumatic Brain Injury in Pediatric Patients. FRONTIERS IN TOXICOLOGY 2022; 4:910972. [PMID: 35812167 PMCID: PMC9263560 DOI: 10.3389/ftox.2022.910972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
The optimal management of severe traumatic brain injury (TBI) in the pediatric population has not been well studied. There are a limited number of research articles studying the management of TBI in children. Given the prevalence of severe TBI in the pediatric population, it is crucial to develop a reference TBI management plan for this vulnerable population. In this review, we seek to delineate the differences between severe TBI management in adults and children. Additionally, we also discuss the known molecular pathogenesis of TBI. A better understanding of the pathophysiology of TBI will inform clinical management and development of therapeutics. Finally, we propose a clinical algorithm for the management and treatment of severe TBI in children using published data.
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Affiliation(s)
- Austin Lui
- Touro University College of Osteopathic Medicine, Vallejo, CA, United States
| | - Kevin K. Kumar
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
- Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital, Palo Alto, CA, United States
| | - Gerald A. Grant
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
- Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital, Palo Alto, CA, United States
- Department of Neurosurgery, Duke University, Durham, NC, United States
- *Correspondence: Gerald A. Grant,
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Gadot R, LoPresti MA, Smith DN, Ouellette L, Lam S. Firearm-Related Pediatric Head Trauma: A Scoping Review. Neurosurgery 2022; 91:239-246. [PMID: 35535986 DOI: 10.1227/neu.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Firearm-related injury is a significant cause of morbidity and mortality in pediatric populations. Despite a disproportionate role in the most morbid outcomes in both traumatic brain injury and firearm-related injury populations, firearm-related traumatic brain injury (frTBI) is an understudied epidemiological entity. There is need to increase understanding and promote interventions that reduce this burden of disease. OBJECTIVE To assess the evidence characterizing pediatric frTBI to highlight trends and gaps regarding burden of disease and interventions to reduce frTBI. METHODS We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) guidelines on peer-reviewed studies across 5 databases (Medline OVID, EMBASE, Web of Science Legal Collection, PsychINFO, and Academic Search Complete). English studies examining pediatric frTBI epidemiology, prevention, and/or social or legal policy advocacy were included. Articles were excluded if they more generally discussed pediatric firearm-related injury without specific analysis of frTBI. RESULTS Six studies satisfied inclusion criteria after screening and full-text assessment. Limited studies specifically addressed the burden of disease caused by frTBI. There was an increased risk for both injury and death from frTBI in men, preteenage and teenage youths, minorities, and individuals in firearm-owning households. Further study is required to ascertain if suggested methods of targeted patient screening, firearm-injury prevention counseling, and advocacy of safety-oriented policy tangibly affect rates or outcomes of pediatric frTBI. CONCLUSION By understanding published epidemiological data and areas of intervention shown to reduce frTBIs, neurosurgeons can become further engaged in public health and prevention rather than strictly treatment after injury.
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Affiliation(s)
- Ron Gadot
- Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Melissa A LoPresti
- Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - David N Smith
- Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Sandi Lam
- Division of Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA.,Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Hubertus V, Finger T, Drust R, Al Hakim S, Schaumann A, Schulz M, Gratopp A, Thomale UW. Severe Traumatic Brain Injury in children-paradigm of decompressive craniectomy compared to a historic cohort. Acta Neurochir (Wien) 2022; 164:1421-1434. [PMID: 35305153 PMCID: PMC9061678 DOI: 10.1007/s00701-022-05171-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/21/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Traumatic brain injury (TBI) is one of the leading causes of death and disability in children. Medical therapy remains limited, and decompressive craniectomy (DC) is an established rescue therapy in case of elevated intracranial pressure (ICP). Much discussion deals with clinical outcome after severe TBI treated with DC, while data on the pediatric population is rare. We report our experience of treating severe TBI in two different treatment setups at the same academic institution. METHODS Forty-eight patients (≤ 16 years) were hospitalized with severe TBI (GCS ≤ 8 points) between 2008 and 2018 in a pediatric intensive care unit (ICU) at a specialized tertiary pediatric care center. Data on treatment, clinical status, and outcome was retrospectively analyzed. Outcome data included Glasgow Outcome Scale (GOS) at 3-, 12-, and 36-month follow-up. Data was compared to a historic cohort with 53 pediatric severe TBI patients treated at the same institution in a neurointensive care unit between 1996 and 2007. Ethical approval was granted (EA2/076/21). RESULTS Between 2008 and 2018, 11 patients were treated with DC. Compared to the historic cohort, patients were younger and GCS was worse, while in-hospital mortality and clinical outcome remained similar. A trend towards more aggressive EVD placement and the internal paradigm change for treatment in a specialized pediatric ICU was observed. CONCLUSIONS In children with severe TBI treated over two decades, clinical outcome was comparable and mostly favorable in two different treatment setups. Consequent therapy is warranted to maintain the positive potential for favorable outcome in children with severe TBI.
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Greenberg JK, Otun A, Kyaw PT, Carpenter CR, Brownson RC, Kuppermann N, Limbrick DD, Foraker RE, Yen PY. Usability and Acceptability of Clinical Decision Support Based on the KIIDS-TBI Tool for Children with Mild Traumatic Brain Injuries and Intracranial Injuries. Appl Clin Inform 2022; 13:456-467. [PMID: 35477149 PMCID: PMC9045962 DOI: 10.1055/s-0042-1745829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) tool is a validated risk prediction model for managing children with mild traumatic brain injuries (mTBI) and intracranial injuries. Electronic clinical decision support (CDS) may facilitate the clinical implementation of this evidence-based guidance. OBJECTIVE Our objective was to evaluate the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. METHODS Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States were recruited to participate in usability testing of a novel CDS prototype in a simulated electronic health record environment. Testing included a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype was updated twice during testing to reflect user feedback. Usability problems recorded in the videos were categorized using content analysis. Interview transcripts were analyzed using thematic analysis. RESULTS Among the 20 participants, most worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, problems with clarity of terminology and navigating through the CDS interface were identified and corrected. Corresponding to these changes, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3 and the number of mistakes made decreased from 18 (phase 1) to 2 (phase 3). Through the survey, participants found the tool easy to use (90%), useful for determining a patient's level of care (95%), and likely to improve resource use (90%) and patient safety (79%). Interview themes related to the CDS's ability to support evidence-based decision-making and improve clinical workflow proposed implementation strategies and potential pitfalls. CONCLUSION After iterative evaluation and refinement, the KIIDS-TBI CDS tool was found to be highly usable and useful for aiding the management of children with mTBI and intracranial injuries.
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Affiliation(s)
- Jacob K Greenberg
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Ayodamola Otun
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Pyi Theim Kyaw
- McKelvey School of Engineering, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Ross C Brownson
- Brown School of Social Work, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis, Davis, California, United States
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Randi E Foraker
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
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Lu ZN, Yeates EO, Grigorian A, Algeo RG, Kuza CM, Chin TL, Donnelly M, Kong A, Nahmias J. Alcohol is not associated with increased mortality in adolescent traumatic brain injury patients. Pediatr Surg Int 2022; 38:599-607. [PMID: 34958420 PMCID: PMC8913449 DOI: 10.1007/s00383-021-05057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Compared to adults, there is a paucity of data regarding the association of a positive alcohol screen (PAS) and outcomes in adolescent patients with traumatic brain injury (TBI). We hypothesize adolescent TBI patients with a PAS on admission to have increased mortality compared to patients with a negative alcohol screen. METHODS The 2017 Trauma Quality Improvement Program database was queried for patients aged 13-17 years presenting with a TBI and serum alcohol screen. Patients with missing information regarding midline shift on imaging and Glasgow Coma Scale (GCS) score were excluded. A multivariable logistic regression analysis for mortality was performed. RESULTS From 2553 adolescent TBI patients with an alcohol screen, 220 (8.6%) had a PAS. Median injury severity scores and rates of penetrating trauma (all p > 0.05) were similar between alcohol positive and negative patients. Patients with a PAS had a similar mortality rate (13.2% vs. 12.1%, p = 0.64) compared to patients with a negative screen. Multivariate logistic regression controlling for risk factors associated with mortality revealed a PAS to confer a similar risk of mortality compared to alcohol negative patients (p = 0.40). CONCLUSION Adolescent TBI patients with a PAS had similar associated risk of mortality compared to patients with a negative alcohol screen.
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Affiliation(s)
- Zachary N. Lu
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA 92868-3298 USA
| | - Eric O. Yeates
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA 92868-3298 USA
| | - Areg Grigorian
- Department of Surgery, University of Southern California (USC), 1520 San Pablo St., Suite 4300, Los Angeles, CA 90033 USA
| | - Russell G. Algeo
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA 92868-3298 USA
| | - Catherine M. Kuza
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, 1250 San Pablo St., Suite 3600, Los Angeles, CA 90033 USA
| | - Theresa L. Chin
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA 92868-3298 USA
| | - Megan Donnelly
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA 92868-3298 USA
| | - Allen Kong
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA 92868-3298 USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA 92868-3298 USA
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A Review of Family Environment and Neurobehavioral Outcomes Following Pediatric Traumatic Brain Injury: Implications of Early Adverse Experiences, Family Stress, and Limbic Development. Biol Psychiatry 2022; 91:488-497. [PMID: 34772505 DOI: 10.1016/j.biopsych.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022]
Abstract
Pediatric traumatic brain injury (TBI) is a public health crisis, with neurobehavioral morbidity observed years after an injury associated with changes in related brain structures. A substantial literature base has established family environment as a significant predictor of neurobehavioral outcomes following pediatric TBI. The neural mechanisms linking family environment to neurobehavioral outcomes have, however, received less empiric study in this population. In contrast, limbic structural differences as well as challenges with emotional adjustment and behavioral regulation in non-TBI populations have been linked to a multitude of family environmental factors, including family stress, parenting style, and adverse childhood experiences. In this article, we systematically review the more comprehensive literature on family environment and neurobehavioral outcomes in pediatric TBI and leverage the work in both TBI and non-TBI populations to expand our understanding of the underlying neural mechanisms. Thus, we summarize the extant literature on the family environment's role in neurobehavioral sequelae in children with TBI and explore potential neural correlates by synthesizing the wealth of literature on family environment and limbic development, specifically related to the amygdala. This review underscores the critical role of environmental factors, especially those predating the injury, in modeling recovery outcomes post-TBI in childhood, and discusses clinical and research implications across pediatric populations. Given the public health crisis of pediatric TBI, along with the context of sparse available medical interventions, a broader understanding of factors contributing to outcomes is warranted to expand the range of intervention targets.
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Piatt JH. Letter to the Editor. For profit, or not for profit. J Neurosurg Pediatr 2022; 29:232-233. [PMID: 34598144 DOI: 10.3171/2021.6.peds21333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joseph H Piatt
- 1Nemours/A. I. duPont Hospital for Children, Wilmington, DE
- 2Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Yue JK, Chang D, Han KJ, Wang AS, Oh T, Sun PP. Management of migrating intracranial bullet fragments in a 13-year-old female after firearm brain injury: technical and surgical nuances. Brain Inj 2022; 36:432-439. [PMID: 35099341 DOI: 10.1080/02699052.2022.2034185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION We present the challenges and nuances of management in a rare case of multiple migrating intracranial fragments after pediatric gunshot wound to the head (GSWH). CASE PRESENTATION A 13-year-old girl suffered left parietal GSWH, with new neurologic decline 3 days after initial debridement. Serial imaging showed the largest intracranial fragments had migrated into the left trigone, and descended further with head of bed (HOB) elevation. HOB was iteratively decreased, with concurrent intracranial pressure monitoring. After extubation, with an alert and stable neurologic exam, HOB was decreased to -15 degrees, allowing gravity-assisted migration of the fragments to an anatomically favorable position within the left occipital horn. The patient underwent occipital craniotomy for fragment retrieval on hospital day 27. Two large and >20 smaller fragments were retrieved using neuronavigation and intraoperative ultrasound. Forensics showed these to be .45 caliber handgun bullet fragments. The patient recovered well after 2-months of intensive inpatient rehabilitation. DISCUSSION During new neurologic decline after GSWH, bullet migration must be considered and serial cranial imaging is requisite. Surgical retrieval of deep fragments requires judicious planning to minimize further injury. Tightly controlled HOB adjustments with gravity assistance for repositioning of fragments may have utility in optimizing anatomic favorability prior to surgery.
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Affiliation(s)
- John K Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Diana Chang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Kasey J Han
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Albert S Wang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Taemin Oh
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Peter P Sun
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
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Beez T, Schuhmann MU, Frassanito P, Di Rocco F, Thomale UW, Bock HC. Protocol for the multicentre prospective paediatric craniectomy and cranioplasty registry (pedCCR) under the auspices of the European Society for Paediatric Neurosurgery (ESPN). Childs Nerv Syst 2022; 38:1461-1467. [PMID: 35532778 PMCID: PMC9325798 DOI: 10.1007/s00381-022-05540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In the paediatric age group, the overall degree of evidence regarding decompressive craniectomy (DC) and cranioplasty is low, whereas in adults, randomised controlled trials and prospective multicentre registries are available. To improve the evidence-based treatment of children, a consensus was reached to establish a prospective registry under the auspices of the European Society for Pediatric Neurosurgery (ESPN). METHODS This international multicentre prospective registry is aimed at collecting information on the indication, timing, technique and outcome of DC and cranioplasty in children. The registry will enrol patients ≤ 16 years of age at the time of surgery, irrespective of the underlying medical condition. The study design comprises four obligatory entry points as a core dataset, with an unlimited number of further follow-up entry points to allow documentation until adolescence or adulthood. Study centres should commit to complete data entry and long-term follow-up. RESULTS Data collection will be performed via a web-based portal (homepage: www.pedccr.com ) in a central anonymised database after local ethics board approval. An ESPN steering committee will monitor the project's progress, coordinate analyses of data and presentation of results at conferences and in publications on behalf of the study group. CONCLUSION The registry aims to define predictors for optimal medical care and patient-centred treatment outcomes. The ultimate goal of the registry is to generate results that are so relevant to be directly transferred into clinical practice to enhance treatment protocols.
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Affiliation(s)
- Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Martin U. Schuhmann
- grid.411544.10000 0001 0196 8249Pediatric Neurosurgery, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Paolo Frassanito
- grid.414603.4Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federico Di Rocco
- grid.414103.3Service de Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Lyon, France
| | - Ulrich W. Thomale
- grid.6363.00000 0001 2218 4662Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans Christoph Bock
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, Universitätsmedizin Göttingen, Göttingen, Germany
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Pelletier JH, Rakkar J, Simon D, Au AK, Fuhrman DY, Clark RS, Kochanek PM, Horvat CM. Association between pediatric TBI mortality and median family income in the United States: A retrospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 5. [PMID: 35252952 PMCID: PMC8896657 DOI: 10.1016/j.lana.2021.100164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND There are regional disparities in pediatric traumatic brain injury (TBI) mortality across the United States, but the factors underlying these differences are unclear. METHODS We performed a retrospective cross-sectional analysis of the Pediatric Health Information System database including inpatient hospital encounters for children less than 18 years old with a primary diagnosis of TBI between 2010-2019. FINDINGS Lower median family income was associated with pediatric TBI mortality. Encounters from zip-codes with a median family income of <$20,000 had a 3.1% (29/950) mortality, as opposed to 1.3% (29/2,267) mortality for zip-codes with a median family income of >$80,000 (p = 0.00096). In multivariable logistic regression, every $10,000 of income was associated with an odds ratio of mortality of 0.94 (95% confidence interval 0.90 - 0.98). 82.5% (397/481) of ballistic TBI injuries were caused by a firearm. Lower income was associated with a higher proportion of ballistic TBI injuries (2.5% [24/950] for <$20,000 versus 0.3% [7/2,267] for >$80,000, p < 0.0001). In multivariable logistic regression, ballistic TBI injuries were associated with an odds ratio of mortality of 5.19 (95% confidence interval 4.00 - 6.73). United States regional variation in pediatric TBI mortality was linearly associated with the percentage of ballistic TBI (adjusted r-squared 0.59, p = 0.0097). INTERPRETATION Children from lower income zip-codes are more likely to sustain a ballistic TBI, and more likely to die. Further work is necessary to determine causal factors underlying these associations and to design interventions that prevent these injuries and/or improve outcomes.
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Affiliation(s)
- Jonathan H. Pelletier
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jaskaran Rakkar
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dennis Simon
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alicia K. Au
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dana Y. Fuhrman
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert S.B. Clark
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Patrick M. Kochanek
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher M. Horvat
- Department Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Brain Care Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of Health Informatics, UPMC Children's Hospital of Pittsburgh; Pittsburgh, PA, USA
- Corresponding Author: Christopher Horvat, Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, United States. +1 412-692-5298.
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Ding X, Liu G, Qian S, Zeng J, Wang Y, Chu J, Chen Q, Chen J, Duan Y, Jin D, Huang J, Lu X, Guo Y, Shi X, Huo X, Su J, Cheng Y, Yin Y, Xin X, Sun Z, Zhao S, Miao H, Lou Z, Li J, Jiang J, Dong S. Epidemiology of Cardiopulmonary Arrest and Outcome of Resuscitation in PICU Across China: A Prospective Multicenter Cohort Study. Front Pediatr 2022; 10:811819. [PMID: 35573969 PMCID: PMC9096021 DOI: 10.3389/fped.2022.811819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the epidemiology and the effectiveness of resuscitation from cardiopulmonary arrest (CPA) among critically ill children and adolescents during pediatric intensive care unit (PICU) stay across China. METHODS A prospective multicenter study was conducted in 11 PICUs in tertiary hospitals. Consecutively hospitalized critically ill children, from 29-day old to 18-year old, who had suffered from CPA and required cardiopulmonary resuscitation (CPR) in the PICU were enrolled (December 2017-October 2018). Data were collected and analyzed using the "in-hospital Utstein style." Neurological outcome was assessed with the Pediatric Cerebral Performance Category (PCPC) scale among children who had survived. Factors associated with the return of spontaneous circulation (ROSC) and survival at discharge were evaluated using multivariate logistic regression. RESULTS Among 11,599 admissions to PICU, 372 children (3.2%) had CPA during their stay; 281 (75.5%) received CPR, and 91 (24.5%) did not (due to an order of "Do Not Resuscitate" requested by their guardians). Cardiopulmonary disease was the most common reason for CPA (28.1% respiratory and 19.6% circulatory). The most frequent initial dysrhythmia was bradycardia (79%). In total, 170 (60.3%) of the total children had an ROSC, 91 had (37.4%) survived till hospital discharge, 28 (11.5%) had survived 6 months, and 19 (7.8%) had survived for 1 year after discharge. Among the 91 children who were viable at discharge, 47.2% (43/91) received a good PCPC score (1-3). The regression analysis results revealed that the duration of CPR and the dose of epinephrine were significantly associated with ROSC, while the duration of CPR, number of CPR attempts, ventricular tachycardia/ventricular fibrillation (VT/VF), and the dose of epinephrine were significantly associated with survival at discharge. CONCLUSION The prevalence of CPA in critically ill children and adolescents is relatively high in China. The duration of CPR and the dose of epinephrine are associated with ROSC. The long-term prognosis of children who had survived after CPR needs further improvement.
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Affiliation(s)
- Xin Ding
- Department of Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Suyun Qian
- Department of Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiansheng Zeng
- Department of Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Department of Pediatric Intensive Care Unit, Xi'an Children's Hospital, Xi'an, China
| | - Jianping Chu
- Department of Pediatric Intensive Care Unit, Xi'an Children's Hospital, Xi'an, China
| | - Qing Chen
- Department of Pediatric Intensive Care Unit, Guiyang Maternal and Child Health Care Hospital, Guiyang, China
| | - Jianli Chen
- Department of Pediatric Intensive Care Unit, Guiyang Maternal and Child Health Care Hospital, Guiyang, China
| | - Yuanyuan Duan
- Department of Pediatric Intensive Care Unit, Anhui Children's Hospital, Hefei, China
| | - Danqun Jin
- Department of Pediatric Intensive Care Unit, Anhui Children's Hospital, Hefei, China
| | - Jiaotian Huang
- Department of Pediatric Intensive Care Unit, Children's Hospital of Hunan Province, Changsha, China
| | - Xiulan Lu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Hunan Province, Changsha, China
| | - Yanmei Guo
- Department of Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang, China
| | - Xiaona Shi
- Department of Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang, China
| | - Ximin Huo
- Department of Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang, China
| | - Jun Su
- Department of Pediatric Intensive Care Unit, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yibing Cheng
- Department of Pediatric Intensive Care Unit, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yi Yin
- Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaowei Xin
- Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhengyun Sun
- Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shaodong Zhao
- Department of Pediatric Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hongjun Miao
- Department of Pediatric Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, China
| | | | - Jun Li
- Jinan Children's Hospital, Jinan, China
| | - Jinghui Jiang
- Department of Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng, China
| | - Shengying Dong
- Department of Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng, China
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Ackah M, Gazali Salifu M, Osei Yeboah C. Estimated incidence and case fatality rate of traumatic brain injury among children (0-18 years) in Sub-Saharan Africa. A systematic review and meta-analysis. PLoS One 2021; 16:e0261831. [PMID: 34968399 PMCID: PMC8717989 DOI: 10.1371/journal.pone.0261831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Studies from Sub-Saharan Africa (SSA) countries have reported on the incidence and case fatality rate of children with Traumatic Brain Injury (TBI). However, there is lack of a general epidemiologic description of the phenomenon in this sub-region underpinning the need for an accurate and reliable estimate of incidence and outcome of children (0-18 years) with TBI. This study therefore, extensively reviewed data to reliably estimate incidence, case fatality rate of children with TBI and its mechanism of injury in SSA. METHODS Electronic databases were systematically searched in English via Medline (PubMed), Google Scholar, and Africa Journal Online (AJOL). Two independent authors performed an initial screening of studies based on the details found in their titles and abstracts. Studies were assessed for quality/risk of bias using the modified Newcastle-Ottawa Scale (NOS). The pooled case fatality rate and incidence were estimated using DerSimonian and Laird random-effects model (REM). A sub-group and sensitivity analyses were performed. Publication bias was checked by the funnel plot and Egger's test. Furthermore, trim and fill analysis was used to adjust for publication bias using Duval and Tweedie's method. RESULTS Thirteen (13) hospital-based articles involving a total of 40685 participants met the inclusion criteria. The pooled case fatality rate for all the included studies in SSA was 8.0%; [95% CI: 3.0%-13.0%], and the approximate case fatality rate was adjusted to 8.2%, [95% CI:3.4%-13.0%], after the trim-and-fill analysis was used to correct for publication bias. A sub-group analysis of sub-region revealed that case fatality rate was 8% [95% CI: 2.0%-13.0%] in East Africa, 1.0% [95% CI: 0.1% -3.0%] in Southern Africa and 18.0% [95% CI: 6.0%-29.0%] in west Africa. The pooled incidence proportion of TBI was 18% [95% CI: 2.0%-33.0%]. The current review showed that Road Traffic Accident (RTA) was the predominant cause of children's TBI in SSA. It ranged from 19.1% in South Africa to 79.1% in Togo. CONCLUSION TBI affects 18% of children aged 0 to 18 years, with almost one-tenth dying in SSA. The most common causes of TBI among this population in SSA were RTA and falls. TBI incidence and case fatality rate of people aged 0-18 years could be significantly reduced if novel policies focusing on reducing RTA and falls are introduced and implemented in SSA.
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Affiliation(s)
- Martin Ackah
- Department of Physiotherapy, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Mohammed Gazali Salifu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
- Policy Planning Budgeting Monitoring and Evaluation Directorate, Ministry of Health, Accra, Ghana
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Qian ZJ, Megwalu UC, Cheng AG, Balakrishnan K. Outpatient healthcare use and outcomes after pediatric tracheostomy. Int J Pediatr Otorhinolaryngol 2021; 151:110963. [PMID: 34736006 DOI: 10.1016/j.ijporl.2021.110963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To 1) describe health outcomes and outpatient healthcare use after pediatric tracheostomy, and 2) identify populations with higher morbidity that may benefit from improved post-operative monitoring. METHODS Optum's commercial insurance database was queried from 2003 to 2019. Children aged 0-18 who received tracheostomy identified. Mortality, decannulation, tracheostomy complications, and home ventilator dependence were determined, as well as physician office visits and specialty type. The effect that patient characteristics (age, sex, ethnicity, prematurity, and presence versus absence of chronic lung disease [CLD], congenital heart disease [CHD], neurologic impairment [NI], and upper airway obstruction [UAO]) had on outcomes were compared. RESULTS 1231 children were identified. Infants accounted for 33% of patients and 40% of the cohort was premature. The most common comorbid conditions were NI (76%), UAO (69%), CLD (48%), and CHD (35%). Within 5 years postoperatively, 25% died, 45% had home ventilator dependence, 53% had a complication, and 10% were decannulated. CHD was associated with higher risk of death (HR,1.98; 95% CI 1.22, 3.21), while UAO was associated with lower risk of death (HR,0.51; 95% CI 0.32, 0.83) and higher probability of decannulation (HR,3.56, 95% CI 1.08, 11.74). The median number of physician office visits was 6 per year (IQR 3,10). The most common specialty types were pediatrics (32%), pulmonary medicine (10%), and otolaryngology (8%). NI was associated with greater number of office visits (mean difference/year, 4.10; 95% CI 2.00, 6.19) while Hispanic ethnicity was associated with fewer visits (mean difference/year, -2.94; 95%CI -5.42, -0.45). CONCLUSIONS UAO was associated with lower risk of mortality and higher probability of decannulation, while NI was associated with greater outpatient healthcare utilization. Social disparities in outpatient tracheostomy care were observed.
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Affiliation(s)
- Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA.
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Kelly KA, Patel PD, Salwi S, Iii HNL, Naftel R. Socioeconomic health disparities in pediatric traumatic brain injury on a national level. J Neurosurg Pediatr 2021:1-7. [PMID: 34740192 DOI: 10.3171/2021.7.peds20820] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Low socioeconomic status is a determinant of pediatric traumatic brain injury (TBI) incidence and severity. In this study, the authors used National (Nationwide) Inpatient Sample (NIS) data to evaluate socioeconomic and health disparities among children hospitalized after TBI. METHODS This retrospective study identified pediatric patients aged 0 to 19 years with ICD-9 codes for TBI in the NIS database from 2012 to 2015. Socioeconomic variables included race, sex, age, census region, and median income of the patient residential zip code. Outcomes included mechanism of injury, hospital length of stay (LOS), cost, disposition at discharge, death, and inpatient complications. Multivariate linear regressions in log scale were built for LOS and cost. Logistic regressions were built for death, disposition, and inpatient complications. RESULTS African American, Hispanic, and Native American patients experienced longer LOSs (β 0.06, p < 0.001; β 0.03, p = 0.03; β 0.13, p = 0.02, respectively) and increased inpatient costs (β 0.13, p < 0.001; β 0.09, p < 0.001; β 0.14, p = 0.03, respectively). Females showed increased rates of medical complications (OR 1.57, p < 0.001), LOS (β 0.025, p = 0.02), and inpatient costs (p = 0.04). Children aged 15 to 19 years were less likely to be discharged home (OR 3.99, p < 0.001), had increased mortality (OR 1.32, p = 0.03) and medical complications (OR 1.84, p < 0.001), and generated increased costs (p < 0.001). CONCLUSIONS The study results have demonstrated that racial minorities, females, older children, and children in lower socioeconomic groups were at increased risk of poor outcomes following TBI, including increased LOS, medical complications, mortality, inpatient costs, and worse hospital disposition. Public education and targeted funding for these groups will ensure that all children have equal opportunity for optimal clinical outcomes following TBI.
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Affiliation(s)
| | - Pious D Patel
- 1Vanderbilt University School of Medicine, Nashville
| | - Sanjana Salwi
- 1Vanderbilt University School of Medicine, Nashville
| | - Harold N Lovvorn Iii
- 2Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville; and
| | - Robert Naftel
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Soysal E, Horvat CM, Simon DW, Wolf MS, Tyler-Kabara E, Gaines BA, Clark RS, Kochanek PM, Bayır H. Clinical Deterioration and Neurocritical Care Utilization in Pediatric Patients With Glasgow Coma Scale Score of 9-13 After Traumatic Brain Injury: Associations With Patient and Injury Characteristics. Pediatr Crit Care Med 2021; 22:960-968. [PMID: 34038066 PMCID: PMC8570972 DOI: 10.1097/pcc.0000000000002767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To define the clinical characteristics of hospitalized children with moderate traumatic brain injury and identify factors associated with deterioration to severe traumatic brain injury. DESIGN Retrospective cohort study. SETTING Tertiary Children's Hospital with Level 1 Trauma Center designation. PATIENTS Inpatient children less than 18 years old with an International Classification of Diseases code for traumatic brain injury and an admission Glasgow Coma Scale score of 9-13. MEASUREMENTS AND RESULTS We queried the National Trauma Data Bank for our institutional data and identified 177 patients with moderate traumatic brain injury from 2010 to 2017. These patients were then linked to the electronic health record to obtain baseline and injury characteristics, laboratory data, serial Glasgow Coma Scale scores, CT findings, and neurocritical care interventions. Clinical deterioration was defined as greater than or equal to 2 recorded values of Glasgow Coma Scale scores less than or equal to 8 during the first 48 hours of hospitalization. Thirty-seven patients experienced deterioration. Children who deteriorated were more likely to require intubation (73% vs 26%), have generalized edema, subdural hematoma, or contusion on CT scan (30% vs 8%, 57% vs 37%, 35% vs 16%, respectively), receive hypertonic saline (38% vs 7%), undergo intracranial pressure monitoring (24% vs 0%), were more likely to be transferred to inpatient rehabilitation following hospital discharge (32% vs 5%), and incur greater costs of care ($25,568 vs $10,724) (all p < 0.01). There was no mortality in this cohort. Multivariable regression demonstrated that a higher Injury Severity Score, a higher initial international normalized ratio, and a lower admission Glasgow Coma Scale score were associated with deterioration to severe traumatic brain injury in the first 48 hours (p < 0.05 for all). CONCLUSIONS A substantial subset of children (21%) presenting with moderate traumatic brain injury at a Level 1 pediatric trauma center experienced deterioration in the first 48 hours, requiring additional resource utilization associated with increased cost of care. Deterioration was independently associated with an increased international normalized ratio higher Injury Severity Score, and a lower admission Glasgow Coma Scale score.
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Affiliation(s)
- Elif Soysal
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Christopher M. Horvat
- Department of Critical Care Medicine, University of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
| | - Dennis W. Simon
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Michael S. Wolf
- Safar Center for Resuscitation Research, University of Pittsburgh
- Department of Pediatrics, Division of Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | - Robert S.B. Clark
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Children’s Neuroscience Institute, Children’s Hospital of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Children’s Neuroscience Institute, Children’s Hospital of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Hülya Bayır
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Environmental and Occupational Health, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Children’s Neuroscience Institute, Children’s Hospital of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
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