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Tang SJ, Mor S, Fine JR, Zwienenberg M, Shahlaie K. Post-traumatic hyperoxia after pediatric TBI. Brain Inj 2024; 38:889-895. [PMID: 38747037 DOI: 10.1080/02699052.2024.2354851] [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: 01/31/2024] [Revised: 03/25/2024] [Accepted: 05/08/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Hyperoxia has been suggested as a mechanism for secondary injury following adult traumatic brain injury (TBI), but its effects have not been well described in pediatric patients. METHODS Pediatric (≤18yo) TBI patients were identified in a prospective institutional registry from October 2008 to April 2022. The first, highest, and the Area Under the Curve (AUC) PaO2 in the first 24 hours were collected and calculated for each patient from arterial blood gas reports after admission to the ICU. Neurological outcome after 6 months was measured using dichotomized modified Rankin Scale (mRS) and Glasgow Outcome Scale - Extended (GOS-E). Multivariable logistic regression models were used to determine if the three measurements for hyperoxia predicted an unfavorable outcome after controlling for well-established clinical and imaging predictors of outcome. RESULTS We identified 98 pediatric patients with severe accidental TBI during the study period. Hyperoxia (PaO2 > 300 mmHg) occurred in 33% of the patients. The presence of elevated PaO2 values, determined by all three evaluations of hyperoxia, was not associated with unfavorable outcome after 6 months. CONCLUSION Utilizing multiple methods to assess exposure, hyperoxia was present in a substantial number of patients with severe TBI but was not associated with an unfavorable outcome.
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Affiliation(s)
- Si Jie Tang
- Department of Neurological Surgery, University of California Davis, Davis, California, USA
| | - Sirjan Mor
- Department of Neurological Surgery, University of California Davis, Davis, California, USA
| | - Jeffrey R Fine
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Marike Zwienenberg
- Department of Neurological Surgery, University of California Davis, Davis, California, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Davis, California, USA
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Smith AM, Ray TJ, Hulitt AA, Vita SM, Warrington JP, Santos CDSE, Grayson BE. High-fat diet consumption negatively influences closed-head traumatic brain injury in a pediatric rodent model. Exp Neurol 2024; 379:114888. [PMID: 39009176 DOI: 10.1016/j.expneurol.2024.114888] [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: 04/02/2024] [Revised: 06/28/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024]
Abstract
Traumatic brain injury (TBI) is one of the most common causes of emergency room visits in children, and it is a leading cause of death in juveniles in the United States. Similarly, a high proportion of this population consumes diets that are high in saturated fats, and millions of children are overweight or obese. The goal of the present study was to assess the relationship between diet and TBI on cognitive and cerebrovascular outcomes in juvenile rats. In the current study, groups of juvenile male Long Evans rats were subjected to either mild TBI via the Closed-Head Injury Model of Engineered Rotational Acceleration (CHIMERA) or underwent sham procedures. The animals were provided with either a combination of high-fat diet and a mixture of high-fructose corn syrup (HFD/HFCS) or a standard chow diet (CH) for 9 days prior to injury. Prior to injury, the animals were trained on the Morris water maze for three consecutive days, and they underwent a post-injury trial on the day of the injury. Immediately after TBI, the animals' righting reflexes were tested. Four days post-injury, the animals were euthanized, and brain samples and blood plasma were collected for qRT-PCR, immunohistochemistry, and triglyceride assays. Additional subsets of animals were used to investigate cerebrovascular perfusion using Laser Speckle and perform immunohistochemistry for endothelial cell marker RECA. Following TBI, the righting reflex was significantly increased in TBI rats, irrespective of diet. The TBI worsened the rats' performance in the post-injury trial of the water maze at 3 h, p(injury) < 0.05, but not at 4 days post-injury. Reduced cerebrovascular blood flow using Laser Speckle was demonstrated in the cerebellum, p(injury) < 0.05, but not foci of the cerebral cortices or superior sagittal sinus. Immunoreactive staining for RECA in the cortex and corpus callosum was significantly reduced in HFD/HFCS TBI rats, p < 0.05. qRT-PCR showed significant increases in APOE, CREB1, FCGR2B, IL1B, and IL6, particularly in the hippocampus. The results from this study offer robust evidence that HFD/HFCS negatively influences TBI outcomes with respect to cognition and cerebrovascular perfusion of relevant brain regions in the juvenile rat.
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Affiliation(s)
- Allie M Smith
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, United States of America.
| | - Trenton J Ray
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, United States of America.
| | - Alicia A Hulitt
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, United States of America.
| | - Sydney M Vita
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70116, United States of America.
| | - Junie P Warrington
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, United States of America.
| | | | - Bernadette E Grayson
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, United States of America; Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS 39216, United States of America; Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS 39216, United States of America.
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3
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Zeldovich M, Krol L, Koerte IK, Cunitz K, Kieslich M, Henrich M, Brockmann K, Buchheim A, Lendt M, Auer C, Neu A, Driemeyer J, Wartemann U, Thomé C, Pinggera D, Berweck S, Bonfert MV, Suss J, Muehlan H, von Steinbuechel N. A short scale to measure health-related quality of life after traumatic brain injury in children and adolescents (QOLIBRI-OS-KID/ADO): psychometric properties and German reference values. Qual Life Res 2024:10.1007/s11136-024-03764-3. [PMID: 39215856 DOI: 10.1007/s11136-024-03764-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The impact of pediatric traumatic brain injury (pTBI) on health-related quality of life (HRQoL) in children and adolescents remains understudied. Short scales have some advantages in terms of economy and administration over longer scales, especially in younger children. The aim of the present study is to psychometrically evaluate the six-item German version of the QOLIBRI-OS-KID/ADO scale for children and adolescents. In addition, reference values from a general German pediatric population are obtained to assist clinicians and researchers in the interpretation of HRQoL after pTBI. METHODS A total of 297 individuals after TBI and 1997 from a general population sample completed the questionnaire. Reliability, validity, and comparability of the assessed construct were examined. RESULTS The questionnaire showed satisfactory reliability (α = 0.75 and ω = 0.81 and α = 0.85 and ω = 0.86 for the TBI and general population samples, respectively). The QOLIBRI-OS-KID/ADO was highly correlated with its long version (R2 = 67%) and showed an overlap with disease-specific HRQoL (R2 = 55%) in the TBI sample. The one-dimensional factorial structure could be replicated and tested for measurement invariance between samples, indicating a comparable HRQoL construct assessment. Therefore, reference values and cut-offs indicating clinically relevant impairment could be provided using percentiles stratified by factors significantly associated with the total score in the regression analyses (i.e., age group and gender). CONCLUSION In combination with the cut-offs, the QOLIBRI-OS-KID/ADO provides a cost-effective screening tool, complemented by interpretation guidelines, which may help to draw clinical conclusions and indications such as further administration of a longer version of the instrument to gain more detailed insight into impaired HRQoL domains or omission of further steps in the absence of an indication.
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Affiliation(s)
- Marina Zeldovich
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria.
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria.
| | - Leonie Krol
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Inga K Koerte
- cBRAIN / Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Boston, USA
| | - Katrin Cunitz
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt, Germany
| | - Marlene Henrich
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt, Germany
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Goettingen, Germany
| | - Anna Buchheim
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Meerbusch, Germany
| | - Christian Auer
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
- Clinical Research Institute für Neurosciences, Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Axel Neu
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Geesthacht, Germany
| | - Joenna Driemeyer
- Department of Pediatrics, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Wartemann
- Department of Neuropediatrics, VAMED Klinik Hohenstücken GmbH, Brandenburg an der Havel, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University lnnsbruck, Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University lnnsbruck, Innsbruck, Austria
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Vogtareuth, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Development and Children with Medical Complexity, Dr. Von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | - Joachim Suss
- Department of Pediatric Surgery, Wilhelmstift Catholic Children's Hospital, Hamburg, Germany
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Nicole von Steinbuechel
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
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Agarwal N, Fan A, Huang X, Dehkharghani S, van der Kolk A. ISMRM Clinical Focus Meeting 2023: "Imaging the Fire in the Brain". J Magn Reson Imaging 2024. [PMID: 39193867 DOI: 10.1002/jmri.29587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 08/29/2024] Open
Abstract
Set during the Annual Meeting of the International Society for Magnetic Resonance in Medicine (ISMRM), the "Clinical Focus Meeting" (CFM) aims to bridge the gap between innovative magnetic resonance imaging (MRI) scientific research and daily patient care. This initiative is dedicated to maximizing the impact of MRI technology on healthcare outcomes for patients. At the 2023 Annual Meeting, clinicians and scientists from across the globe were invited to discuss neuroinflammation from various angles (entitled "Imaging the Fire in the Brain"). Topics ranged from fundamental mechanisms and biomarkers of neuroinflammation to the role of different contrast mechanisms, including both proton and non-proton techniques, in brain tumors, autoimmune disorders, and pediatric neuroinflammatory diseases. Discussions also delved into how systemic inflammation can trigger neuroinflammation and the role of the gut-brain axis in causing brain inflammation. Neuroinflammation arises from various external and internal factors and serves as a vital mechanism to mitigate tissue damage and provide neuroprotection. Nonetheless, excessive neuroinflammatory responses can lead to significant tissue injury and subsequent neurological impairments. Prolonged neuroinflammation can result in cellular apoptosis and neurodegeneration, posing severe consequences. MRI can be used to visualize these consequences, by detecting blood-brain barrier damage, characterizing brain lesions, quantifying edema, and identifying specific metabolites. It also facilitates monitoring of chronic changes in both the brain and spinal cord over time, potentially leading to better patient outcomes. This paper represents a summary of the 2023 CFM, and is intended to guide the enthusiastic MR user to several key and novel sequences that MRI offers to image pathophysiologic processes underlying acute and chronic neuroinflammation. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Nivedita Agarwal
- Diagnostic Imaging and Neuroradiology Unit, IRCCS Scientific Institute E. Medea, Bosisio Parini, Lecco, Italy
| | - Audrey Fan
- Department of Neurology, University of California Davis Health, Sacramento, California, USA
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Xiaoqi Huang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Seena Dehkharghani
- Department of Radiology, Albert Einstein College of Medicine-Montefiore Health, New York, New York, USA
| | - Anja van der Kolk
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
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Morello A, Schiavetti I, Lo Bue E, Portonero I, Colonna S, Gatto A, Pavanello M, Lanotte MM, Garbossa D, Cofano F. Update on the role of S100B in traumatic brain injury in pediatric population: a meta-analysis. Childs Nerv Syst 2024:10.1007/s00381-024-06565-8. [PMID: 39177800 DOI: 10.1007/s00381-024-06565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE Cranial computed tomography (CT) scan is the most widely used tool to rule out intracranial lesions after pediatric traumatic brain injury (TBI). However, in pediatric population, the radiation exposure can lead to an increased risk of hematological and brain neoplasm. Defined in 2019 National Institute for Health and Care Excellence (NICE) guidelines as "troponins for the brain", serum biomarkers measurements, particularly S100B, have progressively emerged as a supplementary tool in the management of TBI thanks to their capacity to predict intracranial post-traumatic lesions. METHODS This systematic review was conducted following the PRISMA protocol (preferred reporting items for systematic reviews and meta-analyses). No chronological limits of study publications were included. Studies reporting data from children with TBI undergoing serum S100B measurement and computed tomography (CT) scans were included. RESULTS Of 380 articles screened, 10 studies met the inclusion criteria. Patients admitted with mild-TBI in the Emergency Department (ED) were 1325 (80.25%). The overall pooled sensitivity and specificity were 98% (95% CI, 92-99%) and 45% (95% CI, 29-63%), respectively. The meta-analysis revealed a high negative predictive value (NVP) (99%; 95% CI, 94-100%) and a low positive predictive value (PPV) (41%; 95% CI, 16-79%). Area under the curve (AUC) was 76% (95% CI, 65-85%). The overall pooled negative predictive value (NPV) was 99% (95% CI, 99-100%). CONCLUSIONS The measurement of serum S100B in the diagnostic workflow of mTBI could help informed decision-making in the ED setting, potentially safely reducing the use of CT scan in the pediatric population. The high sensitivity and excellent negative predictive values look promising and seem to be close to the values found in adults. Despite this, it must be pointed out the high heterogeneity (> 90%) found among studies. In order for S100B to be regularly introduced in the pediatric workflow for TBI, it is important to conduct further studies to obtain cut-off levels based on pediatric reference intervals.
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Affiliation(s)
- Alberto Morello
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy.
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Enrico Lo Bue
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Irene Portonero
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Stefano Colonna
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Andrea Gatto
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michele Maria Lanotte
- Stereotactic and Functional Neurosurgery Unit, Department of Neuroscience, Rita Levi Montalcini", AOU Città Della Salute E Della Scienza Di Torino, University Hospital, University of Turin, Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute E Della Scienza" University Hospital, University of Turin, 10124, Turin, Italy
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Zhao Y, Zhang J, Yu H, Hou X, Zhang J. Noninvasive microvascular imaging in newborn rats using high-frequency ultrafast ultrasound. Neuroimage 2024; 297:120738. [PMID: 39009248 DOI: 10.1016/j.neuroimage.2024.120738] [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: 12/21/2023] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024] Open
Abstract
Ultrasound imaging stands as the predominant modality for neonatal health assessment, with recent advancements in ultrafast Doppler (μDoppler) technology offering significant promise in fields such as neonatal brain imaging. Combining μDoppler with high-frequency ultrasound (HF-μDoppler) presents a potential efficient avenue to enhance in vivo microvascular imaging in small animals, notably newborn rats, a crucial preclinical animal model for neonatal disease and development research. It is necessary to verify the imaging performance of HF-μDoppler in preclinical trials. This study investigates the microvascular imaging capabilities of HF-μDoppler using a 30 MHz high-frequency linear array probe in newborn rats. Results demonstrate the clarity of cerebral microvascular imaging in rats aged 1 to 7 postnatal days, extending to whole-body microvascular imaging, encompassing the central nervous system, including the brain and spinal cord. In conclusion, HF-μDoppler technology emerges as a reliable imaging tool, offering a new perspective for preclinical investigations into neonatal diseases and development.
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Affiliation(s)
- Yunlong Zhao
- Department of Pediatrics, Peking University First Hospital, Beijing, China; Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Jiabin Zhang
- College of Future Technology, Peking University, Beijing, China.
| | - Hao Yu
- College of Engineering, Peking University, Beijing, China
| | - Xinlin Hou
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China; College of Engineering, Peking University, Beijing, China
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Maxson R, Leland CR, Meshram P, Goldfarb SI, Okeke L, McFarland EG. Epidemiology of Pediatric Dog Walking-Related Injuries Among Children Presenting to US Emergency Departments, 2001 to 2020. J Pediatr Orthop 2024; 44:e574-e579. [PMID: 38899976 DOI: 10.1097/bpo.0000000000002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Dog walking is associated with a significant injury burden among adults, but the risk of injury associated with dog walking among children is poorly understood. This study describes the epidemiology of children treated at US emergency departments for injuries related to leash-dependent dog walking. METHODS The National Electronic Injury Surveillance System (NEISS) database was retrospectively analyzed to identify children (5 to 18 years of age) presenting to US emergency departments between 2001 and 2020 with dog walking-related injuries. Primary outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for fracture or traumatic brain injury (TBI). Weighted estimates, odds ratios (ORs), and 95% confidence intervals (CIs) were generated using NEISS sample weights. RESULTS An estimated 35,611 children presented to US emergency departments with injuries related to dog walking. The mean age of patients was 11 years, and most patients were girls (63%). Over half (55%) of injuries were orthopaedic, and patients commonly injured their upper extremity (57%) and were hurt while falling when pulled or tripped by the leash (55%). The most frequent injuries were wrist strain/sprain (5.6%), finger strain/sprain (5.4%), and ankle strain/sprain (5.3%). On multivariable analysis, injured children aged 5 to 11 years were more likely to have sustained a TBI (OR: 3.2, 95% CI: 1.1-9.7) or fracture (OR: 1.6; 95% CI: 1.1-2.3). Boys were more likely than girls to have experienced a fracture (OR: 2.0, 95% CI: 1.3-2.5). CONCLUSIONS Dog walking-related injuries in children are primarily orthopaedic and involve the upper extremity. Younger children and boys are at greater risk for serious dog walking-related injuries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ridge Maxson
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher R Leland
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Prashant Meshram
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah I Goldfarb
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laurence Okeke
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edward G McFarland
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD
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Li W, Shepherd DET, Espino DM. Frequency and time dependent viscoelastic characterization of pediatric porcine brain tissue in compression. Biomech Model Mechanobiol 2024; 23:1197-1207. [PMID: 38483696 DOI: 10.1007/s10237-024-01833-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/20/2024] [Indexed: 08/24/2024]
Abstract
Understanding the viscoelastic behavior of pediatric brain tissue is critical to interpret how external mechanical forces affect head injury in children. However, knowledge of the viscoelastic properties of pediatric brain tissue is limited, and this reduces the biofidelity of developed numeric simulations of the pediatric head in analysis of brain injury. Thus, it is essential to characterize the viscoelastic behavior of pediatric brain tissue in various loading conditions and to identify constitutive models. In this study, the pediatric porcine brain tissue was investigated in compression with determine the viscoelasticity under small and large strain, respectively. A range of frequencies between 0.1 and 40 Hz was applied to determine frequency-dependent viscoelastic behavior via dynamic mechanical analysis, while brain samples were divided into three strain rate groups of 0.01/s, 1/s and 10/s for compression up to 0.3 strain level and stress relaxation to obtain time-dependent viscoelastic properties. At frequencies above 20 Hz, the storage modulus did not increase, while the loss modulus increased continuously. With strain rate increasing from 0.01/s to 10/s, the mean stress at 0.1, 0.2 and 0.3 strain increased to approximate 6.8, 5.6 and 4.4 times, respectively. The brain compressive response was sensitive to strain rate and frequency. The characterization of brain tissue will be valuable for development of head protection systems and prediction of brain injury.
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Affiliation(s)
- Weiqi Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.
| | - Duncan E T Shepherd
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
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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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10
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Lolk K, Werenberg Dreier J, Christensen J. Individual and neighborhood-level socioeconomic deprivation and risk of epilepsy after traumatic brain Injury: A register-based cohort study. Epilepsy Behav 2024; 156:109807. [PMID: 38678986 DOI: 10.1016/j.yebeh.2024.109807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Kasper Lolk
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark.
| | - Julie Werenberg Dreier
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Young D, Cawood S, Mares K, Duschinsky R, Hardeman W. Strategies supporting parent-delivered rehabilitation exercises to improve motor function after paediatric traumatic brain injury: A systematic review. Dev Med Child Neurol 2024; 66:836-848. [PMID: 37794644 DOI: 10.1111/dmcn.15773] [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: 04/21/2023] [Revised: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
AIM To identify and analyse ways in which parents are supported to deliver rehabilitation exercises to their child after traumatic brain injury (TBI), conceptualized as strategies. METHOD A systematic search was completed using seven online databases and three grey literature databases, from inception to November 2021. The included studies focused on physical rehabilitation in children after TBI with the involvement of parents as hands-on deliverers or facilitators of rehabilitation (e.g. supervising the exercise). Intervention descriptions were reviewed to identify strategies; this was followed by fine-grained analysis using the Behaviour Change Wheel to identify intervention components. Risk of bias was analysed using the revised Cochrane Risk-of-Bias Tool for Randomized Trials or the Risk Of Bias In Non-randomized Studies - of Interventions. RESULTS Six interventions including 211 participants and one trial protocol met the inclusion criteria. All studies included a proportion of children diagnosed with TBI and four studies included mixed samples of acquired brain injury or cerebral palsy. All interventions included elements of goal setting and instruction. INTERPRETATION Interventions focus heavily on the initiation of physical rehabilitation, but focus less on the longer-term maintenance of rehabilitation delivery. Further research should integrate perspectives from parents to inform the development of new interventions. WHAT THIS PAPER ADDS Parents need support to deliver or supervise rehabilitation exercises. The interventions identified in this review supported goal setting, action planning, and learning rehabilitation exercises. Interventions focused primarily on the initiation of exercises but less on maintenance. Rehabilitation is complex and new approaches are needed to better support parents.
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Affiliation(s)
- David Young
- School of Health Sciences, University of East Anglia, Norwich, UK
- Women and Children's Services, Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Cawood
- Women and Children's Services, Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK
| | - Kathryn Mares
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Robbie Duschinsky
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
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Nasef H, Chin B, Breeding T, Bundschu N, Wright DD, Plumely D, Elkbuli A. Impact of Trauma Center Type on Outcomes in Pediatric Population Following Severe Isolated Blunt Traumatic Brain Injuries: A National Analysis. Am Surg 2024:31348241262432. [PMID: 38900905 DOI: 10.1177/00031348241262432] [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: 06/22/2024]
Abstract
INTRODUCTION This study aims to evaluate the association between trauma center type, verification level, and clinical outcomes in pediatric trauma patients with moderate and severe isolated blunt traumatic brain injury (TBI). METHODS This is a retrospective cohort study utilizing the American College of Surgeons (ACS) Trauma Quality Program (TQP) Participant Use File (PUF) database from 2017 to 2021. Severely injured pediatric (<18 years) trauma patients with isolated moderate and severe TBI (AIS head >2, all other body regions <3) were included. Outcomes included in-hospital mortality, discharge disposition, intensive care unit length-of-stay (ICU-LOS), and ventilator-free days (VFDs). RESULTS Patients treated at a level-I combined adult and pediatric trauma centers (CTCs) had significantly lower odds of in-hospital mortality than those treated at adult trauma centers (ATCs) (OR .495, 95% CI 0.291-.841, P = .009). Patients treated at level-I pediatric trauma centers (PTCs) (OR 2.726, 95% CI 2.059-3.609, P < .001) and level-II PTCs (OR 6.18, 95% CI 3.402-11.239, P < .001) were significantly more likely to be discharged home than equivalent-level ATCs. CONCLUSION Pediatric patients with isolated blunt moderate and severe TBI treated at level-I PTCs and CTCs had reduced odds of in-hospital mortality compared to level-I ATCs. Patients at level I and II PTCs had significantly higher odds of discharge home than those at equivalent-level CTCs and ATCs.
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Affiliation(s)
- Hazem Nasef
- Kiran Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Brian Chin
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Tessa Breeding
- Kiran Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Nikita Bundschu
- Kiran Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - D-Dre Wright
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Donald Plumely
- Department of Pediatric Surgery, Orlando Health, Arnold Palmer Children's Hospital, Orlando, FL, USA
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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13
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Naseri Alavi SA, Habibi MA, Majdi A, Hajikarimloo B, Rashidi F, Fathi Tavani S, Minaee P, Eazi SM, Kobets AJ. Investigating the Safety and Efficacy of Therapeutic Hypothermia in Pediatric Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:701. [PMID: 38929280 PMCID: PMC11201645 DOI: 10.3390/children11060701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/24/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Prior guidelines recommended maintaining normothermia following traumatic brain injury (TBI), but recent studies suggest therapeutic hypothermia as a viable option in pediatric cases. However, some others demonstrated a higher mortality rate. Hence, the impact of hypothermia on neurological symptoms and overall survival remains contentious. METHODS We conducted a systematic review and meta-analysis to evaluate the effects of hypothermia on neurological outcomes in pediatric TBI patients. The PubMed/Medline, Scopus, and Web of Science databases were searched until 1 January 2024 and data were analyzed using appropriate statistical methods. RESULTS A total of eight studies, comprising nine reports, were included in this analysis. Our meta-analysis did not reveal significant differences in mortality (RR = 1.58; 95% CI = 0.89-2.82, p = 0.055), infection (RR = 0.95: 95% CI = 0.79-1.1, p = 0.6), arrhythmia (RR = 2.85: 95% CI = 0.88-9.2, p = 0.08), hypotension (RR = 1.54: 95% CI = 0.91-2.6, p = 0.10), intracranial pressure (SMD = 5.07: 95% CI = -4.6-14.8, p = 0.30), hospital length of stay (SMD = 0.10; 95% CI = -0.13-0.3, p = 0.39), pediatric intensive care unit length of stay (SMD = 0.04; 95% CI = -0.19-0.28, p = 0.71), hemorrhage (RR = 0.86; 95% CI = 0.34-2.13, p = 0.75), cerebral perfusion pressure (SMD = 0.158: 95% CI = 0.11-0.13, p = 0.172), prothrombin time (SMD = 0.425; 95% CI = -0.037-0.886, p = 0.07), and partial thromboplastin time (SMD = 0.386; 95% CI = -0.074-0.847, p = 0.10) between the hypothermic and non-hypothermic groups. However, the heart rate was significantly lower in the hypothermic group (-1.523 SMD = -1.523: 95% CI = -1.81--1.22 p < 0.001). CONCLUSIONS Our findings challenge the effectiveness of therapeutic hypothermia in pediatric TBI cases. Despite expectations, it did not significantly improve key clinical outcomes. This prompts a critical re-evaluation of hypothermia's role as a standard intervention in pediatric TBI treatment.
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Affiliation(s)
| | - Mohammad Amin Habibi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14399, Iran
| | - Alireza Majdi
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neuroscience, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Bardia Hajikarimloo
- Department of Neurosurgery, Shohada Tajjrish Hospital, Shahid Beheshti University of Medical Science, Tehran 14399, Iran
| | - Farhang Rashidi
- School of Medicine, Tehran University of Medical Sciences, Tehran 14399, Iran
| | - Sahar Fathi Tavani
- School of Medicine, Tehran University of Medical Sciences, Tehran 14399, Iran
| | - Poriya Minaee
- Student Research Committee, Faculty of Medicine, Qom University of Medical Sciences, Qom 999067, Iran
| | - Seyed Mohammad Eazi
- Student Research Committee, Faculty of Medicine, Qom University of Medical Sciences, Qom 999067, Iran
| | - Andrew J. Kobets
- Department of Neurological Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10467, USA
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14
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McNamara CR, Even KM, Kalinowski A, Horvat CM, Gaines BA, Richardson WM, Simon DW, Kochanek PM, Berger RP, Fink EL. Multiorgan Dysfunction Syndrome in Abusive and Accidental Pediatric Traumatic Brain Injury. Neurocrit Care 2024; 40:1099-1108. [PMID: 38062303 PMCID: PMC11147737 DOI: 10.1007/s12028-023-01887-y] [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: 07/05/2023] [Accepted: 10/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Abusive head trauma (AHT) is a mechanism of pediatric traumatic brain injury (TBI) with high morbidity and mortality. Multiorgan dysfunction syndrome (MODS), defined as organ dysfunction in two or more organ systems, is also associated with morbidity and mortality in critically ill children. Our objective was to compare the frequency of MODS and evaluate its association with outcome between AHT and accidental TBI (aTBI). METHODS This was a single center, retrospective cohort study including children under 3 years old admitted to the pediatric intensive care unit with nonpenetrating TBI between 2014 and 2021. Presence or absence of MODS on days 1, 3, and 7 using the Pediatric Logistic Organ Dysfunction-2 score and new impairment status (Functional Status Scale score change > 1 compared with preinjury) at hospital discharge (HD), short-term timepoint, and long-term timepoint were abstracted from the electronic health record. Multiple logistic regression was performed to examine the association between MODS and TBI mechanism with new impairment status. RESULTS Among 576 children, 215 (37%) had AHT and 361 (63%) had aTBI. More children with AHT had MODS on days 1 (34% vs. 23%, p = 0.003), 3 (28% vs. 6%, p < 0.001), and 7 (17% vs. 3%, p < 0.001) compared with those with aTBI. The most common organ failures were cardiovascular ([AHT] 66% vs. [aTBI] 66%, p = 0.997), neurologic (33% vs. 16%, p < 0.001), and respiratory (34% vs. 15%, p < 0.001). MODS was associated with new impairment in multivariable logistic regression at HD (odds ratio 19.1 [95% confidence interval 9.8-38.6, p < 0.001]), short-term discharge (7.4 [3.7-15.2, p < 0.001]), and long-term discharge (4.3 [2.0-9.4, p < 0.001])]. AHT was also associated with new impairment at HD (3.4 [1.6-7.3, p = 0.001]), short-term discharge (2.5 [1.3-4.7, p = 0.005]), and long-term discharge (2.1 [1.1-4.1, p = 0.036]). CONCLUSIONS Abusive head trauma as a mechanism was associated with MODS following TBI. Both AHT mechanism and MODS were associated with new impairment at all time points.
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Affiliation(s)
- Caitlin R McNamara
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Katelyn M Even
- Department of Pediatric Critical Care Medicine, Pennsylvania State University, State College, PA, USA
| | - Anne Kalinowski
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher M Horvat
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara A Gaines
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Ward M Richardson
- Department of Pediatric Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dennis W Simon
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick M Kochanek
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel P Berger
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ericka L Fink
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Sadoway A, Kinden R, Erdogan M, Kureshi N, Johnson M, Green RS, Emsley JG. Epidemiology and factors associated with mortality among pediatric major trauma patients in Nova Scotia: A 17-year retrospective analysis. Injury 2024; 55:111484. [PMID: 38490850 DOI: 10.1016/j.injury.2024.111484] [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: 11/29/2023] [Revised: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Major traumatic injury in the pediatric population requires further evaluation to improve patient outcomes. Relatively few Canadian studies have investigated pediatric trauma using population-based data. Our objectives were to describe the epidemiology of pediatric major trauma in Nova Scotia and identify factors associated with in-hospital mortality. METHODS Retrospective cohort study of pediatric major trauma patients (age <18 years) injured in Nova Scotia over a 17-year period (April 2001-March 2018). Data were collected from the Nova Scotia Trauma Registry. Characteristics were compared between patient subgroups using t-tests, chi-square analyses and Fisher's exact test. Temporal trends were evaluated using the Mann-Kendall test. Incidence and mortality rates were mapped using ArcGIS Pro. A multivariate logistic regression model was created to assess for factors associated with in-hospital mortality. RESULTS A total of 1258 injuries were observed over the 17-year study period. The incidence of pediatric major trauma was 41.7 per 100,000 person-years. Most patients were male (819/1258; 65.1 %) and resided in urban areas (764/1258; 60.7 %). Blunt trauma accounted for 86.2 % (1084/1258) of injuries, and motor vehicle collisions were the most common cause (448/1258; 35.6 %). Incidence and mortality rates were highest in the 15-17 year age group, with a trend towards increasing incidence among females (p = 0.011). Mortality was 17.2 % (217/1258) of patients; 10.9 % (137/1258) died pre-hospital. No trends were detected in mortality rates. The regression model showed increased odds of in-hospital mortality for every point increase in the ISS (OR 1.05; 95 % CI 1.02 to 1.09) and for every unit decrease in scene GCS (OR 0.63; 95 % CI 0.56-0.71). Rural patients were 2 times more likely to die in-hospital versus urban patients (OR 2.40; 95 % CI 1.01-5.69), and patients injured at home were 6 times more likely to die compared to those injured in other locations (OR 6.19; 95 % CI 1.01-38.11). CONCLUSION Pediatric trauma remains a major public health issue in Canada and beyond. Greater efforts are required to expand our understanding of trauma epidemiology and develop targeted injury prevention strategies, especially for rural inhabitants.
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Affiliation(s)
- Andrea Sadoway
- Department of Pediatric Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada, S7N 0W8; IWK Health Centre, 5980 University Ave, Halifax, NS, Canada, B3K 6R8
| | - Renee Kinden
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada, B3H 3A7
| | - Mete Erdogan
- Nova Scotia Health Trauma Program, Rm 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, Canada, B3H 2Y9
| | - Nelofar Kureshi
- Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada, B3H 4R2
| | - Michelle Johnson
- IWK Health Centre, 5980 University Ave, Halifax, NS, Canada, B3K 6R8; Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, NL, Canada, A1B 3V6
| | - Robert S Green
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada, B3H 3A7; Nova Scotia Health Trauma Program, Rm 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, Canada, B3H 2Y9; Department of Critical Care, Dalhousie University, Halifax, NS, Canada, B3H 4R2
| | - Jason G Emsley
- IWK Health Centre, 5980 University Ave, Halifax, NS, Canada, B3K 6R8; Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada, B3H 3A7; Nova Scotia Health Trauma Program, Rm 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, Canada, B3H 2Y9.
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Bergus KC, Patterson KN, Asti L, Bricker J, Beyene TJ, Schulz LN, Schwartz DM, Thakkar RK, Sribnick EA. Association of initial assessment variables and mortality in severe pediatric traumatic brain injury. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000718. [PMID: 38818384 PMCID: PMC11138288 DOI: 10.1136/wjps-2023-000718] [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: 10/25/2023] [Accepted: 05/07/2024] [Indexed: 06/01/2024] Open
Abstract
Background Predictive scales have been used to prognosticate long-term outcomes of traumatic brain injury (TBI), but gaps remain in predicting mortality using initial trauma resuscitation data. We sought to evaluate the association of clinical variables collected during the initial resuscitation of intubated pediatric severe patients with TBI with in-hospital mortality. Methods Intubated pediatric trauma patients <18 years with severe TBI (Glasgow coma scale (GCS) score ≤8) from January 2011 to December 2020 were included. Associations between initial trauma resuscitation variables (temperature, pulse, mean arterial blood pressure, GCS score, hemoglobin, international normalized ratio (INR), platelet count, oxygen saturation, end tidal carbon dioxide, blood glucose and pupillary response) and mortality were evaluated with multivariable logistic regression. Results Among 314 patients, median age was 5.5 years (interquartile range (IQR): 2.2-12.8), GCS score was 3 (IQR: 3-6), Head Abbreviated Injury Score (hAIS) was 4 (IQR: 3-5), and most had a severe (25-49) Injury Severity Score (ISS) (48.7%, 153/314). Overall mortality was 26.8%. GCS score, hAIS, ISS, INR, platelet count, and blood glucose were associated with in-hospital mortality (all p<0.05). As age and GCS score increased, the odds of mortality decreased. Each 1-point increase in GCS score was associated with a 35% decrease in odds of mortality. As hAIS, INR, and blood glucose increased, the odds of mortality increased. With each 1.0 unit increase in INR, the odds of mortality increased by 1427%. Conclusions Pediatric patients with severe TBI are at substantial risk for in-hospital mortality. Studies are needed to examine whether earlier interventions targeting specific parameters of INR and blood glucose impact mortality.
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Affiliation(s)
- Katherine C Bergus
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kelli N Patterson
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Josh Bricker
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lauren N Schulz
- Neurologic Surgery, The Ohio State University, Columbus, Ohio, USA
- Neurologic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dana M Schwartz
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rajan K Thakkar
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Eric A Sribnick
- Neurologic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Andersson E, Öst M, Dalla K, Zetterberg H, Blennow K, Nellgård B. Acute-Phase Neurofilament Light and Glial Fibrillary Acidic Proteins in Cerebrospinal Fluid Predict Long-Term Outcome After Severe Traumatic Brain Injury. Neurocrit Care 2024:10.1007/s12028-024-01998-0. [PMID: 38769253 DOI: 10.1007/s12028-024-01998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND This study investigated trajectory profiles and the association of concentrations of the biomarkers neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) in ventricular cerebrospinal fluid (CSF) with clinical outcome at 1 year and 10-15 years after a severe traumatic brain injury (sTBI). METHODS This study included patients with sTBI at the Neurointensive Care Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. The injury was regarded as severe if patients had a Glasgow Coma Scale ≤ 8 corresponding to Reaction Level Scale ≥ 4. CSF was collected from a ventricular catheter during a 2-week period. Concentrations of NfL and GFAP in CSF were analyzed with enzyme-linked immunosorbent assay. The Glasgow Outcome Scale (GOS) was used to assess the 1-year and 10-15-year outcomes. After adjustment for age and previous neurological diseases, logistic regression was performed for the outcomes GOS 1 (dead) or GOS 2-5 (alive) and GOS 1-3 (poor) or GOS 4-5 (good) versus the independent continuous variables (NfL and GFAP). RESULTS Fifty-three patients with sTBI were investigated; forty-seven adults are presented in the article, and six children (aged 7-18 years) are described in Supplement 1. The CSF concentrations of NfL gradually increased over 2 weeks post trauma, whereas GFAP concentrations peaked on days 3-4. Increasing NfL and GFAP CSF concentrations increased the odds of GOS 1-3 outcome 1 year after trauma (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.07-2.80, p = 0.025; and OR 1.61, 95% CI 1.09-2.37, p = 0.016, respectively). Similarly, increasing CSF concentrations of NfL and GFAP increased the odds for GOS 1-3 outcome 10-15 years after trauma (OR 2.04, 95% CI 1.05-3.96, p = 0.035; and OR 1.60, 95% CI 1.02-2.00, p = 0.040). CONCLUSIONS This study shows that initial high concentrations of NfL and GFAP in CSF are both associated with higher odds for GOS 1-3 outcome 1 year and 10-15 years after an sTBI, implicating its potential usage as a prognostic marker in the future.
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Affiliation(s)
- Emma Andersson
- Department of Anesthesiology and Intensive Care Medicine, Institution of Clinical Sciences, Gothenburg University, Gothenburg, Sweden.
| | - Martin Öst
- Department of Anesthesiology and Intensive Care Medicine, Institution of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care Medicine, Institution of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hongkong Center for Neurodegenerative Diseases, Science Park, Hongkong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Institution of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
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Jung G, Xavier J, Reisert H, Goynatsky M, Keymakh M, Buckner-Wolfson E, Kim T, Fatemi R, Alavi SAN, Pasuizaca A, Shah P, Liriano G, Kobets AJ. Clinical Features and Management of Skull Base Fractures in the Pediatric Population: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:564. [PMID: 38790559 PMCID: PMC11119911 DOI: 10.3390/children11050564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
Pediatric basilar skull fractures (BSFs) are a rare type of traumatic head injury that can cause debilitating complications without prompt treatment. Here, we sought to review the literature and characterize the clinical features, management, and outcomes of pediatric BSFs. We identified 21 relevant studies, excluding reviews, meta-analyses, and non-English articles. The incidence of pediatric BSFs ranged from 0.0001% to 7.3%, with falls from multi-level heights and traffic accidents being the primary causes (9/21). The median presentation age ranged from 3.2 to 12.8 years, and the mean age of patients across all studies was 8.68 years. Up to 55% of pediatric BSFs presented with intracranial hematoma/hemorrhage, along with pneumocephalus and edema. Cranial nerve palsies were a common complication (9/21), with the facial nerve injured most frequently (7/21). While delayed cranial nerve palsy was reported in a few studies (4/21), most resolved within three months post-admission. Other complications included CSF leaks (10/21) and meningitis (4/21). Management included IV fluids, antiemetics, and surgery (8/21) to treat the fracture directly, address a CSF leak, or achieve cranial nerve compression. Despite their rarity, pediatric skull base fractures are associated with clinical complications, including CSF leaks and cranial nerve palsies. Given that some of these complications may be delayed, patient education is critical.
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Affiliation(s)
- Geena Jung
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Jorden Xavier
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Hailey Reisert
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | | | - Margaret Keymakh
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Emery Buckner-Wolfson
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Timothy Kim
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Ryan Fatemi
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Seyed Ahmad Naseri Alavi
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY 10461, USA; (S.A.N.A.); (G.L.); (A.J.K.)
| | - Andres Pasuizaca
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Pushti Shah
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th Street, Bronx, NY 10461, USA; (J.X.); (H.R.); (M.K.); (E.B.-W.); (T.K.); (R.F.); (A.P.); (P.S.)
| | - Genesis Liriano
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY 10461, USA; (S.A.N.A.); (G.L.); (A.J.K.)
| | - Andrew J. Kobets
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY 10461, USA; (S.A.N.A.); (G.L.); (A.J.K.)
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19
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Zhang JK, Dinh TU, Teasdale G, Mercier P, Mattei TA. The Message of the Glasgow Coma Scale: A Comprehensive Bibliometric Analysis and Systematic Review of Clinical Practice Guidelines Spanning the Past 50 years. World Neurosurg 2024; 185:393-402.e27. [PMID: 38437980 DOI: 10.1016/j.wneu.2024.02.139] [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: 09/08/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Despite the ubiquitous use of the Glasgow Coma Scale (GCS) worldwide, no study to date has objectively and quantitatively assessed its impact on the scientific literature and clinical practice. Therefore, we comprehensively analyzed scientific publications and clinical practice guidelines employing the GCS to gauge its clinical and academic impact, identify research hotspots, and inform future research on the topic. METHODS A cross-sectional bibliometric analysis was performed on Scopus to obtain relevant publications incorporating the GCS from 1974 to 2022. In addition, a systematic review of existing clinical practice guidelines in PubMed, Scopus, Web of Science, and Trip Database was performed. Validated bibliometric parameters including article title, journal, publication year, authors, citation count, country, institution, keywords, impact factor, and references were assessed. When evaluating clinical practice guidelines, the sponsoring organization, country of origin, specialty, and publication year were assessed. RESULTS A total of 37,633 articles originating from 3924 different scientific journals spanning 1974-2022 were included in the final analysis. The compound annual growth rate of publications referencing the GCS was 16.7%. Of 104 countries, the United States had the highest total number of publications employing the GCS (n = 8517). World Neurosurgery was the scientific periodical with the highest number of publications on the GCS (n = 798). The top trending author-supplied keyword was "traumatic brain injury" (n = 3408). The 97 included clinical practice guidelines most commonly employed the GCS in the fields of internal medicine (n = 22, 23%), critical care (n = 21, 22%), and neurotrauma (n = 19, 20%). CONCLUSIONS At the turn of the 50th anniversary of the GCS, we provided a unique and detailed description of the "path to success" of the GCS both in terms of its scientific and clinical impact. These results have not only a historical but also an important didactic value. Ultimately our detailed analysis, which revealed some of the factors that led the GCS to become such a widespread and highly influential score, may assist future researchers in their development of new outcome measures and clinical scores, especially as such tools become increasingly relevant in an evidence-based data-driven age.
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Affiliation(s)
- Justin K Zhang
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA; Department of Neurological Surgery, University of Utah, Salt Lake City, Missouri, USA
| | - Thai Uyen Dinh
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Graham Teasdale
- Emeritus Professor of Neurosurgery, University of Glasgow, Glasgow, United Kingdom
| | - Philippe Mercier
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Tobias A Mattei
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
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20
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Castro M, Agoubi LL, Velonjara J, Lutkevicius C, Guadagnoli N, Lujan S, Petroni G, Bell MJ, Vavilala MS, Mock C. Clinical Epidemiology of Extracranial Injuries in Severe Pediatric Traumatic Brain Injury in South America. Injury 2024; 55:111394. [PMID: 38360517 PMCID: PMC11046303 DOI: 10.1016/j.injury.2024.111394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/10/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a leading cause of pediatric mortality, with a disproportionate burden on low- and middle-income countries. The impact of concomitant extracranial injury (ECI) on these patients remains unclear. This study is the first to characterize the epidemiology and clinical course of severe pediatric TBI with extracranial injuries in any South American country. METHODS We conducted a secondary analysis of baseline data collected prior to implementation of a clinical trial on TBI care in Argentina, Paraguay, and Chile from September 2019 to July 2020. Patients ≤18 years with CT evidence of TBI, and a Glasgow coma scale (GCS) score ≤8 were recruited. Patients were initially stratified by highest non-head abbreviated injury scale (AIS): isolated TBI (AIS=0), minor extracranial injury (MEI; AIS=1-2), and serious extracranial injury (SEI; AIS≥3). Patients were subsequently stratified by mechanism of injury. Intergroup differences were compared using ANOVA, two-tailed unpaired t-tests, and chi-square tests. RESULTS Among the 116 children included, 33 % (n = 38) had an isolated TBI, 34 % (n = 39) had MEI, and 34 % (n = 39) had SEI. Facial (n = 53), thoracic (n = 44), and abdominal (n = 31) injuries were the most common ECIs. At discharge, there were no significant differences in median GCS, GOS, or GOS-extended between groups. Patients with SEI had a longer hospital LOS than those with isolated TBI (median 28.0 (IQR 10.6-40.1) vs 11.9 (IQR 8.7-20.7) days, p = 0.013). The most common mechanisms of injury were road traffic injuries (RTIs) (n = 50, 43 %) and falls (n = 35, 30 %). Patients with RTI-associated TBIs were more likely to be older (median 11.0 (IQR 3.0-14.0) vs 2.0 (IQR 0.8-7.0) years, p<0.001) and more likely to have an ECI (86% vs 54 %, respectively; p = 0.003). ICU and Hospital LOS for RTI patients (median 10.5 (IQR 6.1-21.1) and 24.1 (IQR 11.5-40.4) days) were longer than those of fall patients (median 6.1 (IQR 2.6-8.9) and 13.7 (IQR 7.7-24.5) days). CONCLUSIONS Extracranial injuries are common in South American patients with severe TBI. Severe ECI is more frequently associated with RTIs and can result in a higher rate of surgical procedures and LOS. Further strategies are needed to characterize the prevention and treatment of severe pediatric TBI in the South American context.
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Affiliation(s)
- Miguel Castro
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Lauren L Agoubi
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA.
| | - Julia Velonjara
- Harborview Injury Prevention and Research Center, Seattle, WA, USA; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Silvia Lujan
- Centro de Informática e Investigación Clínica, Rosario, Argentina
| | - Gustavo Petroni
- Centro de Informática e Investigación Clínica, Rosario, Argentina
| | - Michael J Bell
- Children's National Hospital Critical Care Medicine, Washington, DC, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Seattle, WA, USA; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Charles Mock
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA
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21
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von Steinbuechel N, Zeldovich M, Timmermann D, Krenz U, Koerte IK, Bonfert MV, Berweck S, Kieslich M, Henrich M, Brockmann K, Buchheim A, Roediger M, Lendt M, Auer C, Neu A, Kaiser A, Driemeyer J, Greving S, Wartemann U, Pinggera D, Thomé C, Suss J, Muehlan H, Cunitz K. Final Validation of the Quality of Life after Brain Injury for Children and Adolescents (QOLIBRI-KID/ADO) Questionnaire. CHILDREN (BASEL, SWITZERLAND) 2024; 11:438. [PMID: 38671655 PMCID: PMC11049366 DOI: 10.3390/children11040438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Until recently, no disease-specific health-related quality of life (HRQoL) questionnaire existed for pediatric traumatic brain injuries (TBIs). In this revalidation study, the psychometric properties and the validity of the 35-item QOLIBRI-KID/ADO questionnaire in its final German version were examined in 300 children and adolescents. It is the first self-reported TBI-specific tool for measuring pediatric HRQoL in individuals aged between 8 and 17 years. The six-factor model fits the data adequately. The questionnaire's internal consistency was excellent for the total score and satisfactory to excellent for the scale scores. Intraclass correlations indicated good test-retest reliability, and the measure's construct validity was supported by the overlap between the QOLBRI-KID/ADO and the PedsQL, which measures generic HRQoL. The discriminant validity tests showed that older children and girls reported a significantly lower HRQoL than comparison groups, and this was also true of children who were anxious or depressed, or who suffered from post-concussion symptoms, replicating the results of the questionnaire's first developmental study. Our results suggest that the QOLIBRI-KID/ADO is a reliable and valid multidimensional tool that can be used together with the adult version in clinical contexts and research to measure disease-specific HRQoL after pediatric TBI throughout a person's life. This may help improve care, treatment, daily functioning, and HRQoL after TBI.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
| | - Marina Zeldovich
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Dagmar Timmermann
- Department of Psychosomatic Medicine and Psychotherapy, Division of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany;
| | - Ugne Krenz
- University Medical Center Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (U.K.); (S.G.)
| | - Inga K. Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian University Hospital, LMU University, Nussbaumstrasse 5, 80336 Munich, Germany;
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, 55 Fruit Street, Boston, MA 02114, USA
| | - Michaela V. Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, Dr. Von Hauner Children’s Hospital, LMU University Hospital, Haydnstr. 5, 80336 Munich, Germany;
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany;
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.K.); (M.H.)
| | - Marlene Henrich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.K.); (M.H.)
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany;
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
| | - Maike Roediger
- Department of Pediatrics and Adolescent Medicine, General Pediatrics, Intensive Care Medicine and Neonatology & Department of Pediatric Cardiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany;
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Strümper Straße 111, 40670 Meerbusch, Germany;
| | - Christian Auer
- Johannes Kepler University Linz, Altenberger Straße 69, 4020 Linz, Austria;
- Department of Neurosurgery, Kepler Univesity Hospital GmbH, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Axel Neu
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Johannes-Ritter-Straße 100, 21502 Geesthacht, Germany; (A.N.); (A.K.)
| | - Alexander Kaiser
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Johannes-Ritter-Straße 100, 21502 Geesthacht, Germany; (A.N.); (A.K.)
| | - Joenna Driemeyer
- Department of Pediatrics, University of Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;
| | - Sven Greving
- University Medical Center Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (U.K.); (S.G.)
| | - Ulrike Wartemann
- Department of Neuropediatrics, VAMED Klinik Hohenstücken GmbH, Brahmsstraße 38, 14772 Brandenburg an der Havel, Germany;
| | - Daniel Pinggera
- Department of Neurosurgery, Tirol Kliniken GmbH, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.P.); (C.T.)
| | - Claudius Thomé
- Department of Neurosurgery, Tirol Kliniken GmbH, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.P.); (C.T.)
| | - Joachim Suss
- Department of Pediatric Surgery, Wilhelmstift Catholic Children’s Hospital, Liliencronstraße 130, 22149 Hamburg, Germany;
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany;
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany
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Wickbom F, Calcagnile O, Marklund N, Undén J. Validation of the Scandinavian guidelines for minor and moderate head trauma in children: protocol for a pragmatic, prospective, observational, multicentre cohort study. BMJ Open 2024; 14:e078622. [PMID: 38569695 PMCID: PMC11146355 DOI: 10.1136/bmjopen-2023-078622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Mild traumatic brain injury is common in children and it can be challenging to accurately identify those in need of urgent medical intervention. The Scandinavian guidelines for management of minor and moderate head trauma in children, the Scandinavian Neurotrauma Committee guideline 2016 (SNC16), were developed to aid in risk stratification and decision-making in Scandinavian emergency departments (EDs). This guideline has been validated externally with encouraging results, but internal validation in the intended healthcare system is warranted prior to broad clinical implementation. OBJECTIVE We aim to validate the diagnostic accuracy of the SNC16 to predict clinically important intracranial injuries (CIII) in paediatric patients suffering from blunt head trauma, assessed in EDs in Sweden and Norway. METHODS AND ANALYSIS This is a prospective, pragmatic, observational cohort study. Children (aged 0-17 years) with blunt head trauma, presenting with a Glasgow Coma Scale of 9-15 within 24 hours postinjury at an ED in 1 of the 16 participating hospitals, are eligible for inclusion. Included patients are assessed and managed according to the clinical management routines of each hospital. Data elements for risk stratification are collected in an electronic case report form by the examining doctor. The primary outcome is defined as CIII within 1 week of injury. Secondary outcomes of importance include traumatic CT findings, neurosurgery and 3-month outcome. Diagnostic accuracy of the SNC16 to predict endpoints will be assessed by point estimate and 95% CIs for sensitivity, specificity, likelihood ratio, negative predictive value and positive predictive value. ETHICS AND DISSEMINATION The study is approved by the ethical board in both Sweden and Norway. Results from this validation will be published in scientific journals, and a tailored development and implementation process will follow if the SNC16 is found safe and effective. TRIAL REGISTRATION NUMBER NCT05964764.
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Affiliation(s)
- Fredrik Wickbom
- Department of Clinical Sciences, Malmö, Lund University Faculty of Medicine, Lund, Sweden
- Department of Operation and Intensive Care, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden
| | - Olga Calcagnile
- Department of Paediatric Medicine, Halland Hospital Halmstad, Halmstad, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences, Lund University, Lund University, Lund, Sweden
- Department of Neurosurgery, Skåne University Hospital Lund, Lund, Sweden
| | - Johan Undén
- Department of Operation and Intensive Care, Halland Hospital Halmstad, Region Halland, Halmstad, Sweden
- Lund University, Lund, Sweden
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23
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Zhang KY, Li PL, Yan P, Qin CJ, He H, Liao CP. The significance of admission blood lactate and fibrinogen in pediatric traumatic brain injury: a single-center clinical study. Childs Nerv Syst 2024; 40:1207-1212. [PMID: 38147105 DOI: 10.1007/s00381-023-06257-9] [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: 09/13/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in pediatric patients, leading to long-term physical, cognitive, and psychological impairments. Blood lactate and fibrinogen levels have emerged as potential biomarkers associated with tissue hypoperfusion and coagulation dysfunction, respectively. However, limited research has specifically focused on the significance of these biomarkers in pediatric TBI. This study aimed to investigate the clinical significance of blood lactate and fibrinogen levels upon admission in pediatric patients with traumatic brain injury. METHODS The medical records of 80 children with a traumatic brain injury who were admitted from January 2017 to January 2021 were retrospectively analyzed. The two groups were compared according to whether the blood lactate in the admission arterial blood gas increased and the fibrinogen content in the coagulation function decreased. The clinical data of the children in the two groups were different, and then they were divided into a good prognosis group and a poor prognosis group according to the GOS prognostic score, and the differences in the clinical indicators of the two groups were compared. RESULTS Among the 80 patients, 33 had elevated blood lactate levels, 34 had decreased fibrinogen levels, and 29 had an unfavorable outcome (GOS < 4). Compared to the normal blood lactate group, there were no statistically significant differences in age, sex ratio, or platelet count in the elevated blood lactate group (P > 0.05). However, the elevated blood lactate group had lower Glasgow Coma Scale (GCS) scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stay, lower GOS scores, and a higher proportion of GOS < 4 (P < 0.05). Compared to the normal fibrinogen group, there were no statistically significant differences in age, sex ratio, or platelet count in the decreased fibrinogen group (P > 0.05). However, the decreased fibrinogen group had lower GCS scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stays, lower GOS scores, and a higher proportion of GOS < 4 (P < 0.05). Compared to the favorable outcome group, there were no statistically significant differences in age, sex ratio, or platelet count in the unfavorable outcome group (P > 0.05). However, the unfavorable outcome group had lower GCS scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stays, a higher incidence of pulmonary infection, a higher incidence of stress ulcers, and lower GOS scores (P < 0.05). CONCLUSION The levels of blood lactate and fibrinogen may represent the severity of children with traumatic brain injury and may be risk factors for poor prognosis of children with traumatic brain injury.
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Affiliation(s)
- Kun-Yuan Zhang
- Department of Neurosurgery, Second People's Hospital of Pingchang, Pingchang, Sichuan, P.R. China
| | - Pei-Long Li
- Kunming Children's Hospital, Children's Hospital Affiliated to Kunming Medical University, Kunming Medical University, Kunming, P.R. China
| | - Peng Yan
- Department of Neurosurgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, P.R. China
| | - Cheng-Jian Qin
- Department of Neurosurgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, P.R. China
| | - Hao He
- Department of Neurosurgery, Second People's Hospital of Pingchang, Pingchang, Sichuan, P.R. China
| | - Chang-Pin Liao
- Department of Neurosurgery, People's Hospital of Baise, No. 8, Chengxiang Street, Youjiang District, Baise, Guangxi, P.R. China.
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Moore L, Ben Abdeljelil A, Tardif PA, Zemek R, Reed N, Yeates KO, Emery CA, Gagnon IJ, Yanchar N, Bérubé M, Dawson J, Berthelot S, Stang A, Beno S, Beaulieu E, Turgeon AF, Labrosse M, Lauzier F, Pike I, Macpherson A, Freire GC. Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review. Ann Emerg Med 2024; 83:327-339. [PMID: 38142375 DOI: 10.1016/j.annemergmed.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/25/2023]
Abstract
STUDY OBJECTIVE Our primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency department (ED), appraise their overall quality, and synthesize the quality of evidence and the strength of included recommendations. METHODS We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and medical association websites from January 2012 to May 2023 for clinical practice guidelines with at least 1 recommendation targeting pediatric mTBI populations presenting to the ED within 48 hours of injury for any diagnostic or therapeutic intervention in the acute phase of care (ED and inhospital). Pairs of reviewers independently assessed overall clinical practice guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. RESULTS We included 11 clinical practice guidelines, of which 6 (55%) were rated high quality. These included 101 recommendations, of which 34 (34%) were based on moderate- to high-quality evidence, covering initial assessment, initial diagnostic imaging, monitoring/observation, therapeutic interventions, discharge advice, follow-up, and patient and family support. We did not identify any evidence-based recommendations in high-quality clinical practice guidelines for repeat imaging, neurosurgical consultation, or hospital admission. Lack of strategies and tools to aid implementation and editorial independence were the most common methodological weaknesses. CONCLUSIONS We identified 34 recommendations based on moderate- to high-quality evidence that may be considered for implementation in clinical settings. Our review highlights important areas for future research. This review also underlines the importance of providing strategies to facilitate the implementation of clinical practice guideline recommendations for pediatric mTBI.
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Affiliation(s)
- Lynne Moore
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada.
| | - Anis Ben Abdeljelil
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberts, Canada
| | - Isabelle J Gagnon
- Division of Pediatric Emergency Medicine, McGill University Health Centre, Montréal Children's Hospital, Montréal, Québec, Canada
| | - Natalie Yanchar
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Jennifer Dawson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Antonia Stang
- Pediatrics, Emergency Medicine, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Beno
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emilie Beaulieu
- Département de Pédiatrie, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Anesthesiology and Critical Care Medicine Université Laval, Québec City, Québec, Canada
| | - Melanie Labrosse
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Anesthesiology and Critical Care Medicine Université Laval, Québec City, Québec, Canada
| | - Ian Pike
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Gabrielle C Freire
- Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences Program, Peter Gilgan Institute for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
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Al-Khateeb ZF, Boumenar H, Adebimpe J, Shekerzade S, Henson SM, Tremoleda JL, Michael-Titus AT. The cellular senescence response and neuroinflammation in juvenile mice following controlled cortical impact and repetitive mild traumatic brain injury. Exp Neurol 2024; 374:114714. [PMID: 38325653 DOI: 10.1016/j.expneurol.2024.114714] [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] [Revised: 12/11/2023] [Accepted: 02/03/2024] [Indexed: 02/09/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of disability and increases the risk of developing neurodegenerative diseases. The mechanisms linking TBI to neurodegeneration remain to be defined. It has been proposed that the induction of cellular senescence after injury could amplify neuroinflammation and induce long-term tissue changes. The induction of a senescence response post-injury in the immature brain has yet to be characterised. We carried out two types of brain injury in juvenile CD1 mice: invasive TBI using controlled cortical impact (CCI) and repetitive mild TBI (rmTBI) using weight drop injury. The analysis of senescence-related signals showed an increase in γH2AX-53BP1 nuclear foci, p53, p19ARF, and p16INK4a expression in the CCI group, 5 days post-injury (dpi). At 35 days, the difference was no longer statistically significant. Gene expression showed the activation of different senescence pathways in the ipsilateral and contralateral hemispheres in the injured mice. CCI-injured mice showed a neuroinflammatory early phase after injury (increased Iba1 and GFAP expression), which persisted for GFAP. After CCI, there was an increase at 5 days in p16INK4, whereas in rmTBI, a significant increase was seen at 35 dpi. Both injuries caused a decrease in p21 at 35 dpi. In rmTBI, other markers showed no significant change. The PCR array data predicted the activation of pathways connected to senescence after rmTBI. These results indicate the induction of a complex cellular senescence and glial reaction in the immature mouse brain, with clear differences between an invasive brain injury and a repetitive mild injury.
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Affiliation(s)
- Zahra F Al-Khateeb
- Centre for Neuroscience, Surgery and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Hasna Boumenar
- Centre for Neuroscience, Surgery and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Joycee Adebimpe
- Centre for Neuroscience, Surgery and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Shenel Shekerzade
- Centre for Neuroscience, Surgery and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Siân M Henson
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jordi L Tremoleda
- Centre for Neuroscience, Surgery and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Adina T Michael-Titus
- Centre for Neuroscience, Surgery and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Smith AM, Challagundla L, McGee IG, Warfield ZJ, Santos CDSE, Garrett MR, Grayson BE. Temporal shifts to the gut microbiome associated with cognitive dysfunction following high-fat diet consumption in a juvenile model of traumatic brain injury. Physiol Genomics 2024; 56:301-316. [PMID: 38145288 PMCID: PMC11283908 DOI: 10.1152/physiolgenomics.00113.2023] [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: 10/03/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 12/26/2023] Open
Abstract
The gut-brain axis interconnects the central nervous system (CNS) and the commensal bacteria of the gastrointestinal tract. The composition of the diet consumed by the host influences the richness of the microbial populations. Traumatic brain injury (TBI) produces profound neurocognitive damage, but it is unknown how diet influences the microbiome following TBI. The present work investigates the impact of a chow diet versus a 60% fat diet (HFD) on fecal microbiome populations in juvenile rats following TBI. Twenty-day-old male rats were placed on one of two diets for 9 days before sustaining either a Sham or TBI via the Closed Head Injury Model of Engineered Rotational Acceleration (CHIMERA). Fecal samples were collected at both 1- and 9-days postinjury. Animals were cognitively assessed in the novel object recognition tests at 8 days postinjury. Fecal microbiota DNA was isolated and sequenced. Twenty days of HFD feeding did not alter body weight, but fat mass was elevated in HFD compared with Chow rats. TBI animals had a greater percentage of entries to the novel object quadrant than Sham counterparts, P < 0.05. The Firmicutes/Bacteroidetes ratio was significantly higher in TBI than in the Sham, P < 0.05. Microbiota of the Firmicutes lineage exhibited perturbations by both injury and diet that were sustained at both time points. Linear regression analyses were performed to associate bacteria with metabolic and neurocognitive endpoints. For example, counts of Lachnospiraceae were negatively associated with percent entries into the novel object quadrant. Taken together, these data suggest that both diet and injury produce robust shifts in microbiota, which may have long-term implications for chronic health.NEW & NOTEWORTHY Traumatic brain injury (TBI) produces memory and learning difficulties. Diet profoundly influences the populations of gut microbiota. Following traumatic brain injury in a pediatric model consuming either a healthy or high-fat diet (HFD), significant shifts in bacterial populations occur, of which, some are associated with diet, whereas others are associated with neurocognitive performance. More work is needed to determine whether these microbes can therapeutically improve learning following trauma to the brain.
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Affiliation(s)
- Allie M Smith
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Lavanya Challagundla
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Ian G McGee
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Zyra J Warfield
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | | | - Michael R Garrett
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Bernadette E Grayson
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, United States
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, United States
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Krol L, Hagmayer Y, von Steinbuechel N, Cunitz K, Buchheim A, Koerte IK, Zeldovich M. Reference Values for the German Version of the Quality of Life after Brain Injury in Children and Adolescents (QOLIBRI-KID/ADO) from a General Population Sample. J Pers Med 2024; 14:336. [PMID: 38672963 PMCID: PMC11051333 DOI: 10.3390/jpm14040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Assessment of health-related quality of life (HRQoL) after pediatric traumatic brain injury (TBI) has been limited in children and adolescents due to a lack of disease-specific instruments. To fill this gap, the Quality of Life after Traumatic Brain Injury for Children and Adolescents (QOLIBRI-KID/ADO) Questionnaire was developed for the German-speaking population. Reference values from a comparable general population are essential for comprehending the impact of TBI on health and well-being. This study examines the validity of the German QOLIBRI-KID/ADO in a general pediatric population in Germany and provides reference values for use in clinical practice. Overall, 1997 children and adolescents aged 8-17 years from the general population and 300 from the TBI population participated in this study. The questionnaire was tested for reliability and validity. A measurement invariance (MI) approach was used to assess the comparability of the HRQoL construct between both samples. Reference values were determined by percentile-based stratification according to factors that significantly influenced HRQoL in regression analyses. The QOLIBRI-KID/ADO demonstrated strong psychometric properties. The HRQoL construct was measured largely equivalently in both samples, and reference values could be provided. The QOLIBRI-KID/ADO was considered reliable and valid for assessing HRQoL in a general German-speaking pediatric population, allowing for clinically meaningful comparisons between general and TBI populations.
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Affiliation(s)
- Leonie Krol
- Department of Psychology, Clinical Psychology, Experimental Psychopathology, and Psychotherapy, University of Marburg, 35037 Marburg, Germany
| | - York Hagmayer
- Georg-Elias-Müller Institute for Psychology, Georg-August-University, 37073 Goettingen, Germany;
| | - Nicole von Steinbuechel
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
| | - Inga K. Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, 80337 Munich, Germany;
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Marina Zeldovich
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Freudplatz 1, 1020 Vienna, Austria
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Jenkin T, D'Cruz K, Botchway E, Muscara F, Anderson V, Scheinberg A, Knight S. Family involvement in rehabilitation programmes for children and adolescents with acquired brain injury: A scoping literature review. Neuropsychol Rehabil 2024:1-54. [PMID: 38518075 DOI: 10.1080/09602011.2024.2330141] [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: 01/18/2022] [Accepted: 12/22/2023] [Indexed: 03/24/2024]
Abstract
Paediatric acquired brain injury (ABI) can adversely impact families, and it is widely accepted that families should be involved in the rehabilitation of children/adolescents with ABI. However, there is limited guidance about how to best involve families in paediatric ABI rehabilitation. Several programmes involving the families of children/adolescents with ABI have been developed, but there are no published reviews outlining their characteristics. This scoping literature review aimed to synthesize information about these programmes and develop an understanding of how families are involved in them. Four databases were systematically searched to identify sources of evidence that described programmes in paediatric ABI rehabilitation that involve family members. One hundred and eight sources of evidence describing 42 programmes were included. Programmes were categorized as: service coordination (n = 11), psychosocial (n = 17), support groups (n = 4), training/instruction (n = 9), and education (n = 1). Families' involvement in these programmes varied across programme development, delivery, and evaluation stages. The findings of this scoping literature review outline how families can be involved in paediatric ABI rehabilitation. While this review outlines many approaches to supporting families, it also highlights the need for models of family-centred care to better articulate how clinicians and services can involve families in paediatric ABI rehabilitation.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Edith Botchway
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Frank Muscara
- Murdoch Children's Research Institute, Melbourne, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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Yasudome Y, Kubota T, Kusubae R, Ikeda N, Hazeki D, Nomura Y. Traumatic brain injury inducing swift transition from syndrome of inappropriate antidiuretic hormone secretion to central diabetes insipidus: a case report. Clin Pediatr Endocrinol 2024; 33:139-143. [PMID: 38993715 PMCID: PMC11234183 DOI: 10.1297/cpe.2023-0057] [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: 09/09/2023] [Accepted: 02/20/2024] [Indexed: 07/13/2024] Open
Abstract
Heavy traumatic brain injury (TBI) may lead to the manifestation of either syndrome of inappropriate secretion of antidiuretic hormones (SIADH) or central diabetes insipidus (CDI). We present a case of TBI where SIADH transformed into CDI within a remarkably short timeframe. A previously healthy 4-yr-old boy was admitted to our hospital with hyponatremia and elevated urinary sodium level on the day following a traumatic head injury. Within 150 min after initiating SIADH treatment, a significant increase in urine volume and a decrease in urinary sodium levels were observed. Therefore, the treatment plan was modified to include desmopressin. By the 5th day of admission, the urine volume gradually stabilized and normalized without the need for further desmopressin treatment. Mild TBI can give rise to various conditions that may undergo rapid changes. Closely monitoring serum and urine electrolytes, along with urine volume, is imperative for the administration of appropriate and timely treatment.
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Affiliation(s)
- Yuki Yasudome
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Tomohiro Kubota
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Ryo Kusubae
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Naohiro Ikeda
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Daisuke Hazeki
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
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Valdivia-Tangarife ER, Morlett-Paredes A, Rizo-Curiel G, Jiménez-Maldonado ME, Ruiz-Sandoval JL, Barba AR, López-Enríquez A, Avilés-Martínez KI, Villaseñor-Cabrera T. Incidence, and factors associated with moderate/severe pediatric traumatic brain injury in children aged 5-15 years in western, Mexico. Eur J Paediatr Neurol 2024; 49:6-12. [PMID: 38278011 DOI: 10.1016/j.ejpn.2024.01.001] [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: 11/07/2022] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE The study objectives were to estimate the standardized incidence and evaluate factors associated with moderate/severe pediatric traumatic brain injury (p-TBI) in children aged 5-15 years in Western, Mexico. METHODS The study was cross-sectional in design. We estimated the standardized incidence of moderate/severe p-TBI using the direct methods of the World Health Organization (WHO) standard populations. We utilized the Glasgow Coma Scale (GCS) to identify moderate/severe p-TBI patients (GCS ≤ 13). Logistic regression analysis was applied to evaluate variables associated with moderate/severe p-TBI. RESULTS The standardized incidence of patients diagnosed with moderate/severe p-TBI was 31.0/100,000 person-years (95 % CI 28.7-33.4). According to age, the moderate/severe TBI group was included. A total of 254 (38.5 %) patients were aged 5-9 years, 343 (52.0 %) were aged 10-14 years, and 62 (9.5 %) were aged 15 years. Factors associated with moderate/severe TBI in the crude analysis were male sex (OR 5.50, 95 % CI 4.16-7.39, p < 0.001), primary school (OR 2.15, 95 % CI 1.62-2.84, p < 0.001), and falls (OR 1.34, 95 % CI 1.02-1.77, p = 0.035). Factors associated with moderate/severe p-TBI in the adjusted analysis were male sex (OR 6.12, 95 % CI 4.53-8.29, p < 0.001), primary school (OR 3.25, 95 % CI 2.31-4.55, p < 0.001), and falls (OR 1.78, 95 % CI 1.28-2.47, p < 0.001). CONCLUSION The incidence of moderate/severe p-TBI in children aged 5-15 years in western Mexico in this study was higher than that in other studies. One of the biggest factors associated with moderate/severe p-TBI was male sex, specifically those with lower education levels and those who were prone to falls.
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Affiliation(s)
| | | | - Genoveva Rizo-Curiel
- Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico
| | - Miriam E Jiménez-Maldonado
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico
| | | | | | | | | | - Teresita Villaseñor-Cabrera
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico.
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Todorov S, Petrov PP, Kirovakov Z, Penchev P. Epidemiological Study of Traumatic Brain and Spinal Injuries in a Pediatric Population: A One-Year Analysis of Prevalence, Causes and Trends. Cureus 2024; 16:e57224. [PMID: 38686269 PMCID: PMC11056603 DOI: 10.7759/cureus.57224] [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: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are leading causes of morbidity and mortality in pediatric patients. However, the epidemiology of pediatric brain and spine injuries in Bulgaria is poorly documented. This study aims to analyze and identify the prevalence, causes, and trends of traumatic brain and spinal cord injuries in pediatric patients during the period of 1st June 2022 to 30th June 2023. Methods A retrospective study was conducted on the medical records of patients under 18 years of age who visited the emergency department of University Multiprofile Hospital for Active Treatment (UMHAT) Burgas, Bulgaria between 1st June 2022 and 30th June 2023. The incidence and etiology were stratified by age, gender, and anamnesis. Data processing and analysis were performed with the statistical package IBM SPSS v. 26.0 (IBM Corp., Armonk, NY, USA), and graphical analysis with MS Office Excel 2016 (Microsoft, Redmond, WA, USA). Means ± standard deviation and 95% confidence interval were calculated. All p-values less than 0.05 were considered indicative of statistical significance. Results Data for patients aged <18 years, admitted to the emergency department (ED) of UMHAT Burgas, Bulgaria from 1st June 2022 to 30th June 2023 were analyzed (n=38504). Of these patients, 32% were children (n=13857). One hundred thirty-four (0.3%) of the pediatric patients were hospitalized in the neurosurgical ward, and 4653 (10.7%) were hospitalized in other wards. Of the analyzed patients, 89 are boys (66.4%), 45 are girls (33.6%) (male-female ratio 2:1) and the mean age of the patients with a head trauma was 8.07 years old. The average number of patients by diagnosis is 13.4±35.37. The largest percent are patients with brain concussion (85.07%, n=114), followed by contusion of the nerve roots in the lumbar region or late contusion wound of the head (with 2.99% each, n=4); hydrocephalus or skull fracture (with 2.24% each, n=3); contusion of the nerve roots in the thoracic region (1.49%, n=2); and fracture at Th9 vertebrae, fracture at C2 vertebrae, brain trauma or brain tumor (with 0.75% each, n=1). The average number of patients by anamnesis is 13.2±17.99. The largest percent are patients who fall from their own height (44.78%, n=60); followed by falls from height (20.90%, n=28); car accident (7.46%, n=10); injured by fight, fall from a bicycle or incident during a football game (with 5.97% each, n=8); fall from electric scooter (4.48%, n=6); hit in the closet (2.99%, n=4); and finally from bike accident or hit by a rock (with 0.75% each, n=1). From 134 hospitalized patients in neurosurgery, 114 (85.07%) did not require surgical treatment and were treated with conservative treatment and 20 (14.93%) were treated surgically. Conclusion In conclusion, this study highlights a significant burden of pediatric traumatic brain and spinal injuries in Bulgaria. The majority of cases were managed conservatively, emphasizing the need for preventive measures.
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Affiliation(s)
- Svetoslav Todorov
- Neurological Surgery, University Multi-profile Hospital for Active Treatment (UMHAT) "Burgas", Burgas, BGR
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Jaafari O, Salih S, Alkatheeri A, Alshehri M, Al-Shammari M, Maeni M, Alqahtani A, Alomaim W, Hasaneen M. Appropriate incorporation of susceptibility-weighted magnetic resonance imaging into routine imaging protocols for accurate diagnosis of traumatic brain injuries: a systematic review. J Med Life 2024; 17:273-280. [PMID: 39044937 PMCID: PMC11262612 DOI: 10.25122/jml-2023-0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/12/2024] [Indexed: 07/25/2024] Open
Abstract
Traumatic brain injury (TBI) results from physical or traumatic injuries to the brain's surrounding bony structures and associated tissues, which can lead to various sequelae, including simple concussion, acute epidural hematoma, parenchymal contusions, subarachnoid hemorrhage, diffuse axonal injury, and chronic traumatic encephalopathy. Susceptibility-weighted imaging (SWI) has enhanced the accuracy of neuroimaging for these injuries. SWI is based on 3D gradient echo magnetic resonance imaging (MRI) with long echo times and flow compensation. Owing to its sensitivity to deoxyhemoglobin, hemosiderin, iron, and calcium, SWI is extremely informative and superior to conventional MRI for the diagnosis and follow-up of patients with acute, subacute, and prolonged hemorrhage. This systematic review aimed to evaluate and summarize the published articles that report SWI results for the evaluation of TBI and to determine correlations between clinical status and SWI results. Consequently, our analysis also aimed to identify the appropriate MRI sequences to use in the assessment of patients with TBI. We searched the Medline and Embase online electronic databases for relevant papers published from 2012 onwards. We found that SWI had higher sensitivity than gradient echo MRI in detecting and characterizing microbleeds in TBIs and was able to differentiate diamagnetic calcifications from paramagnetic microhemorrhages. However, it is important that future research not only continues to evaluate the utility of SWI in TBIs but also attempts to overcome the limitations of the studies described in this review, which should help validate the conclusions and recommendations from our analysis.
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Affiliation(s)
- Osama Jaafari
- Radiology Department, Royal Commission Medical Center, King Fahad, Al-Nakheel, Yanbu, Saudi Arabia
| | - Suliman Salih
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Al Ain, United Arab Emirates
| | - Ajnas Alkatheeri
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Al Ain, United Arab Emirates
| | - Muhamed Alshehri
- Department of Radiology and Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Majedh Al-Shammari
- Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Mousa Maeni
- Radiology Department, Royal Commission Medical Center, King Fahad, Al-Nakheel, Yanbu, Saudi Arabia
| | - Abdullah Alqahtani
- Radiology Department, Royal Commission Medical Center, King Fahad, Al-Nakheel, Yanbu, Saudi Arabia
| | - Wijdan Alomaim
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Al Ain, United Arab Emirates
| | - Mohamed Hasaneen
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Al Ain, United Arab Emirates
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Fins JJ, Knitter J, Mukherjee D, Conti K, Donleavy-Hiller B, Gerber LM, Hersh JE, Kotorac-Erlbaum R, Milch B, Klein SM. A Descriptive Analysis of Access to Assistive Technology in Children With Acquired Brain Injury: The Right to Assistive Devices. J Head Trauma Rehabil 2024; 39:152-159. [PMID: 37492972 PMCID: PMC10811270 DOI: 10.1097/htr.0000000000000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Pediatric clinicians caring for children with acquired brain injury have noted that many individuals requiring assistive technology (AT) go unserved or face delays until devices are obtained, with potential adverse implications for recovery and development. In this article we map the pathways by which AT is prescribed and assess delays and barriers to access. METHODS We conducted a retrospective chart review of patients with moderate to severe brain injury admitted to Blythedale Children's Hospital over a 2-year period using a database drawn from the medical record. RESULTS We identified 72 children diagnosed with brain injury requiring at least 1 device. Devices were used to improve mobility and positioning, self-care, safety, and communication, and enable access to other technologies and foster social integration. We found that 55% of devices were delivered, with most deliveries to home or the hospital's outpatient department for fitting, training, and instruction. Time to delivery ranged from 12 to 250 days with an average of 69.4 days. Twenty percent of nondeliveries were attributable to change in medical status, transfer to a skilled nursing facility, or continued inpatient status, while 31% were canceled by the family. Other nondeliveries were attributed to insurance coverage. We also found that the medical record is not designed for the longitudinal tracking of devices, indicating the need for a prospective process to document the AT trajectory. CONCLUSION Instead of tolerating delays and denials, there should be a normative expectation that children have a right to medically necessary devices, consistent with disability law. This analysis was undertaken as a step toward formulating a prospective means of tracking AT recommendations, approvals, denials, and/or deliveries. Our findings should be understood as a promissory note toward structural reforms that are reflective of society's responsibility to better meet the needs of vulnerable children and their families.
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Affiliation(s)
- Joseph J Fins
- Author Affiliations: Division of Medical Ethics (Drs Fins and Mukherjee and Ms Hersh) and Department of Population Health Science (Dr Gerber), Weill Cornell Medical College, New York, New York; Solomon Center for Health Law and Policy, Yale Law School, New Haven, Connecticut (Dr Fins); and Blythedale Children's Hospital, Valhalla, New York (Mss Knitter, Donleavy-Hiller, Kotorac-Erlbaum, and Milch and Drs Conti and Klein)
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Proctor A, Lyttle M, Billing J, Shaw P, Simpson J, Voss S, Benger JR. Which elements of hospital-based clinical decision support tools for the assessment and management of children with head injury can be adapted for use by paramedics in prehospital care? A systematic mapping review and narrative synthesis. BMJ Open 2024; 14:e078363. [PMID: 38355171 PMCID: PMC10868315 DOI: 10.1136/bmjopen-2023-078363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to support prehospital clinicians in deciding which head-injured children can safely remain at scene. This study aims to identify clinical decision tools, or constituent elements, which may be adapted for use in prehospital care. DESIGN Systematic mapping review and narrative synthesis. DATA SOURCES Searches were conducted using MEDLINE, EMBASE, PsycINFO, CINAHL and AMED. ELIGIBILITY CRITERIA Quantitative, qualitative, mixed-methods or systematic review research that included a clinical decision support tool for assessing and managing children with head injury. DATA EXTRACTION AND SYNTHESIS We systematically identified all in-hospital clinical decision support tools and extracted from these the clinical criteria used in decision-making. We complemented this with a narrative synthesis. RESULTS Following de-duplication, 887 articles were identified. After screening titles and abstracts, 710 articles were excluded, leaving 177 full-text articles. Of these, 95 were excluded, yielding 82 studies. A further 14 studies were identified in the literature after cross-checking, totalling 96 analysed studies. 25 relevant in-hospital clinical decision tools were identified, encompassing 67 different clinical criteria, which were grouped into 18 categories. CONCLUSION Factors that should be considered for use in a clinical decision tool designed to support paramedics in the assessment and management of children with head injury are: signs of skull fracture; a large, boggy or non-frontal scalp haematoma neurological deficit; Glasgow Coma Score less than 15; prolonged or worsening headache; prolonged loss of consciousness; post-traumatic seizure; amnesia in older children; non-accidental injury; drug or alcohol use; and less than 1 year old. Clinical criteria that require further investigation include mechanism of injury, clotting impairment/anticoagulation, vertigo, length of time of unconsciousness and number of vomits.
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Affiliation(s)
| | - Mark Lyttle
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | | | | | | | - Sarah Voss
- Health and Life Sciences, University of the West of England, Bristol, UK
| | - Jonathan Richard Benger
- Academic Department of Emergency Care, The University Hospitals NHS Foundation Trust, Bristol, UK
- Faculty of Health & Life Sciences, University of the West of England, Bristol, UK
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Hazwani T, Khalifa AM, Azzubi M, Alhammad A, Aloboudi A, Jorya A, Alkhuraiji A, Alhelabi S, Shaheen N. Diffuse axonal injury on magnetic resonance imaging and its relation to neurological outcomes in pediatric traumatic brain injury. Clin Neurol Neurosurg 2024; 237:108166. [PMID: 38364490 DOI: 10.1016/j.clineuro.2024.108166] [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] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Diffuse axonal injury (DAI), a frequent consequence of pediatric traumatic brain injury (TBI), presents challenges in predicting long-term recovery. This study investigates the relationship between the severity of DAI and neurological outcomes in children. METHODS We conducted a retrospective analysis of 51 pediatric TBI patients diagnosed with DAI using Adam's classification. Neurological function was assessed at 2, 3, and 6 weeks, and 12 months post-injury using the Pediatric Glasgow Outcome Scale-Extended (PGOSE). RESULTS PGOSE scores significantly improved over time across all DAI grades, suggesting substantial recovery potential even in initially severe cases. Despite indicating extensive injury, patients with DAI grades II and III demonstrated significant improvement, achieving a good recovery by 12 months. Although the initial Glasgow Coma Scale (GCS) score did not show a statistically significant association with long-term outcomes in our limited sample, these findings suggest that the severity of DAI alone may not fully predict eventual recovery. CONCLUSIONS Our study highlights the potential for significant neurological recovery in pediatric patients with DAI, emphasizing the importance of long-term follow-up and individualized rehabilitation programs. Further research with larger cohorts and extended follow-up periods is crucial to refine our understanding of the complex relationships between DAI severity, injury mechanisms, and long-term neurological outcomes in children.
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Affiliation(s)
- Tarek Hazwani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed M Khalifa
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Moutasem Azzubi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Pediatric Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdullah Alhammad
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Medical Imaging, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdullah Aloboudi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Medical Imaging, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmad Jorya
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Arwa Alkhuraiji
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sarah Alhelabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Naila Shaheen
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Munoz Pareja JC, de Rivero Vaccari JP, Chavez MM, Kerrigan M, Pringle C, Guthrie K, Swaby K, Coto J, Kobeissy F, Avery KL, Ghosh S, Dhanashree R, Shanmugham P, Lautenslager LA, Faulkenberry S, Pareja Zabala MC, Al Fakhri N, Loor-Torres R, Governale LS, Blatt JE, Gober J, Perez PK, Solano J, McCrea H, Thorson C, O'Phelan KH, Keane RW, Dietrich WD, Wang KK. Prognostic and Diagnostic Utility of Serum Biomarkers in Pediatric Traumatic Brain Injury. J Neurotrauma 2024; 41:106-122. [PMID: 37646421 PMCID: PMC11071081 DOI: 10.1089/neu.2023.0039] [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] [Indexed: 09/01/2023] Open
Abstract
Traumatic brain injury (TBI) remains a major cause of morbidity and death among the pediatric population. Timely diagnosis, however, remains a complex task because of the lack of standardized methods that permit its accurate identification. The aim of this study was to determine whether serum levels of brain injury biomarkers can be used as a diagnostic and prognostic tool in this pathology. This prospective, observational study collected and analyzed the serum concentration of neuronal injury biomarkers at enrollment, 24h and 48h post-injury, in 34 children ages 0-18 with pTBI and 19 healthy controls (HC). Biomarkers included glial fibrillary acidic protein (GFAP), neurofilament protein L (NfL), ubiquitin-C-terminal hydrolase (UCH-L1), S-100B, tau and tau phosphorylated at threonine 181 (p-tau181). Subjects were stratified by admission Glasgow Coma Scale score into two categories: a combined mild/moderate (GCS 9-15) and severe (GCS 3-8). Glasgow Outcome Scale-Extended (GOS-E) Peds was dichotomized into favorable (≤4) and unfavorable (≥5) and outcomes. Data were analyzed utilizing Prism 9 and R statistical software. The findings were as follows: 15 patients were stratified as severe TBI and 19 as mild/moderate per GCS. All biomarkers measured at enrollment were elevated compared with HC. Serum levels for all biomarkers were significantly higher in the severe TBI group compared with HC at 0, 24, and 48h. The GFAP, tau S100B, and p-tau181 had the ability to differentiate TBI severity in the mild/moderate group when measured at 0h post-injury. Tau serum levels were increased in the mild/moderate group at 24h. In addition, NfL and p-tau181 showed increased serum levels at 48h in the aforementioned GCS category. Individual biomarker performance on predicting unfavorable outcomes was measured at 0, 24, and 48h across different GOS-E Peds time points, which was significant for p-tau181 at 0h at all time points, UCH-L1 at 0h at 6-9 months and 12 months, GFAP at 48h at 12 months, NfL at 0h at 12 months, tau at 0h at 12 months and S100B at 0h at 12 months. We concluded that TBI leads to increased serum neuronal injury biomarkers during the first 0-48h post-injury. A biomarker panel measuring these proteins could aid in the early diagnosis of mild to moderate pTBI and may predict neurological outcomes across the injury spectrum.
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Affiliation(s)
- Jennifer C. Munoz Pareja
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Juan Pablo de Rivero Vaccari
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria Mateo Chavez
- Knowledge and Research Evaluation Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Kerrigan
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Charlene Pringle
- Department of Pediatric Critical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kourtney Guthrie
- Department of Pediatric Critical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kathryn Swaby
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer Coto
- Department of University of Miami Concussion Program, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Firas Kobeissy
- Department of Emergency Medicine, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
- Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
| | - K. Leslie Avery
- Department of Pediatric Critical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Suman Ghosh
- Department of Pediatric Neurology, Downstate Health Science University, New York, New York, USA
| | - Rajderkar Dhanashree
- Department of Radiology, Division of Pediatric Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Prashanth Shanmugham
- Department of Pediatric Critical Care, UT Southwestern University, Dallas, Texas, USA
| | - Lauren A. Lautenslager
- Department of Plastic Surgery, Indiana University School of Medicine, Bloomington, Indiana, USA
| | - Shannon Faulkenberry
- Department of Pediatric Critical Care, Orlando Regional Medical Center, Orlando, Florida, USA
| | | | - Nora Al Fakhri
- Department of Pediatric Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ricardo Loor-Torres
- Knowledge and Research Evaluation Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Lance S. Governale
- Department of Pediatric Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jason E. Blatt
- Department of Pediatric Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Joslyn Gober
- Department of Pediatric Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paula Karina Perez
- Department of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Juan Solano
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Heather McCrea
- Department of Pediatric Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chad Thorson
- Department of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kristine H. O'Phelan
- Department of Neurology and Neurocritical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert W. Keane
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. Dalton Dietrich
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kevin K. Wang
- Department of Emergency Medicine, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
- Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
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Snowden T, Morrison J, Boerstra M, Eyolfson E, Acosta C, Grafe E, Reid H, Brand J, Galati M, Gargaro J, Christie BR. Brain changes: aerobic exercise for traumatic brain injury rehabilitation. Front Hum Neurosci 2023; 17:1307507. [PMID: 38188504 PMCID: PMC10771390 DOI: 10.3389/fnhum.2023.1307507] [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] [Received: 10/04/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Traumatic Brain Injury (TBI) accounts for millions of hospitalizations and deaths worldwide. Aerobic exercise is an easily implementable, non-pharmacological intervention to treat TBI, however, there are no clear guidelines for how to best implement aerobic exercise treatment for TBI survivors across age and injury severity. Methods We conducted a PRISMA-ScR to examine research on exercise interventions following TBI in children, youth and adults, spanning mild to severe TBI. Three electronic databases (PubMed, PsycInfo, and Web of Science) were searched systematically by two authors, using keywords delineated from "Traumatic Brain Injury," "Aerobic Exercise," and "Intervention." Results Of the 415 papers originally identified from the search terms, 54 papers met the inclusion criteria and were included in this review. The papers were first grouped by participants' injury severity, and subdivided based on age at intervention, and time since injury where appropriate. Discussion Aerobic exercise is a promising intervention for adolescent and adult TBI survivors, regardless of injury severity. However, research examining the benefits of post-injury aerobic exercise for children and older adults is lacking.
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Affiliation(s)
- Taylor Snowden
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Jamie Morrison
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Meike Boerstra
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Eric Eyolfson
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Crystal Acosta
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Erin Grafe
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Hannah Reid
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Justin Brand
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | | | - Judith Gargaro
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Brian R. Christie
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Island Medical Program and Department of Cellular and Physiological Sciences, The University of British Columbia, Victoria, BC, Canada
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Freeman-Jones E, Miller WH, Work LM, Fullerton JL. Polypathologies and Animal Models of Traumatic Brain Injury. Brain Sci 2023; 13:1709. [PMID: 38137157 PMCID: PMC10741988 DOI: 10.3390/brainsci13121709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Traumatic brain injury (TBI) is an important health issue for the worldwide population, as it causes long-term pathological consequences for a diverse group of individuals. We are yet to fully elucidate the significance of TBI polypathologies, such as neuroinflammation and tau hyperphosphorylation, and their contribution to the development of chronic traumatic encephalopathy (CTE) and other neurological conditions. To advance our understanding of TBI, it is necessary to replicate TBI in preclinical models. Commonly used animal models include the weight drop model; these methods model human TBI in various ways and in different animal species. However, animal models have not demonstrated their clinical utility for identifying therapeutic interventions. Many interventions that were successful in improving outcomes for animal models did not translate into clinical benefit for patients. It is important to review current animal models and discuss their strengths and limitations within a TBI context. Modelling human TBI in animals encounters numerous challenges, yet despite these barriers, the TBI research community is working to overcome these difficulties. Developments include advances in biomarkers, standardising, and refining existing models. This progress will improve our ability to model TBI in animals and, therefore, enhance our understanding of TBI and, potentially, how to treat it.
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Affiliation(s)
- Erin Freeman-Jones
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G12 8QQ, UK; (E.F.-J.); (W.H.M.)
| | - William H. Miller
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G12 8QQ, UK; (E.F.-J.); (W.H.M.)
| | - Lorraine M. Work
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK;
| | - Josie L. Fullerton
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK;
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Palavani LB, Bertani R, de Barros Oliveira L, Batista S, Verly G, Andreão FF, Ferreira MY, Paiva WS. A Systematic Review and Meta-Analysis on the Management and Outcome of Isolated Skull Fractures in Pediatric Patients. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1913. [PMID: 38136115 PMCID: PMC10741641 DOI: 10.3390/children10121913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF). MATERIALS AND METHODS This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered. RESULTS A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies. CONCLUSIONS Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.
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Affiliation(s)
- Lucca B. Palavani
- Faculty of Medicine, Max Planck University Center, Indaiatuba 13343-060, Brazil;
| | - Raphael Bertani
- Faculty of Medicine, São Paulo University, São Paulo 05508-220, Brazil
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
| | - Gabriel Verly
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
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Bardak Ş, Berksoy E, Çiçek A, Demir G, Pekçevik Y, Elibol P, Verdi EG, Gökalp G, Nalbant T, Emir B. Variability of the optic nerve sheath diameter on brain computed tomography in Turkish children based on sex and age. Childs Nerv Syst 2023; 39:3551-3560. [PMID: 37010582 DOI: 10.1007/s00381-023-05943-y] [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: 12/29/2022] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) measurement is a noninvasive method that can be used for intracranial pressure monitoring. Several studies have investigated normal ONSD values in children, but no general consensus has been reached yet. OBJECTIVES The aim of our study was to reveal normal ONSD, eyeball transverse diameter (ETD), and ONSD/ETD values on brain computed tomography (CT) in healthy children aged 1 month to 18 years. METHODS Children admitted to the emergency department with minor head trauma and had normal brain CT were included in the study. The demographic characteristics of the patients (age and sex) were recorded, and the patients were divided into four age groups: 1 month to 2 years, 2 to 4 years, 4 to 10 years, and 10 to 18 years. RESULTS The images of 332 patients were analyzed. When the median values of all measurement parameters (right and left ONSD, ETD, and ONSD/ETD) were compared between the right and left eyes, no statistically significant differences were found. When the same parameters were compared according to age group, the ONSD and ETD values differed significantly (values of males were found to be higher), but the ONSD proximal/ETD and ONSD middle/ETD values did not differ significantly. CONCLUSION In our study, normal ONSD, ETD, and ONSD/ETD values were determined according to age and sex in healthy children. As the ONSD/ETD index did not statistically significantly differ according to age and sex, diagnostic studies for traumatic brain injuries can be performed using the index.
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Affiliation(s)
- Şefika Bardak
- Department of Pediatric Emergency, Health Sciences University İzmir Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Emel Berksoy
- Department of Pediatric Emergency, Health Sciences University İzmir Tepecik Education and Research Hospital, Konak, Izmir, Turkey.
| | - Alper Çiçek
- Department of Pediatric Emergency, Health Sciences University İzmir Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Gülşah Demir
- Department of Pediatric Emergency, Health Sciences University İzmir Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Yeliz Pekçevik
- Department of Radiology, Health Sciences University İzmir Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Pelin Elibol
- Department of Pediatric Emergency, Ege University Hospital, Bornova, Izmir, Turkey
| | - Ezgi Güvel Verdi
- Department of Radiology, Health Sciences University İzmir Tepecik Education and Research Hospital, Konak, Izmir, Turkey
| | - Gamze Gökalp
- Department of Pediatric Emergency, İzmir Katip Çelebi University, Konak, Izmir, Turkey
| | - Tuğçe Nalbant
- Department of Pediatric Emergency, İzmir Katip Çelebi University, Konak, Izmir, Turkey
| | - Büşra Emir
- Department of Biostatistics, İzmir Katip Çelebi University, Yeşilyurt, Izmir, Turkey
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Parks A, Hogg-Johnson S. Autonomic nervous system dysfunction in pediatric sport-related concussion: a systematic review. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2023; 67:246-268. [PMID: 38283159 PMCID: PMC10814701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Objective To identify, appraise and synthesize the evidence of autonomic nervous system (ANS) dysfunction following sport-related concussion in pediatric populations. Methods A literature search was conducted using MEDLINE (Ovid), SportDiscus (EBSCO), CINAHL (EBSCO), EMBASE (Ovid) and PsycINFO (Ovid). Studies were selected and appraised using the Joanna Briggs Institute (JBI) critical appraisal tools. Data was extracted from the included studies and qualitatively synthesized. Results Eleven studies were included in the synthesis. There was variability in the methods used to measure ANS function between studies, and sample populations and time to assessment following concussion varied considerably. There was also variability in the direction of change of ANS function between some studies. Conclusion This systematic review identifies that concussion is associated with dysregulation of ANS function in pediatric athletes. We identified some weaknesses in the extant literature which may be due to existing logistical and financial barriers to implementing valid ANS measurements in clinical and sports settings.
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Affiliation(s)
- Andrew Parks
- Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College
- Private Practice
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College
- Dalla Lana School of Public Health, University of Toronto
- Institute for Disability and Rehabilitation Research, Ontario Tech University
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Gerard J, Van Gent JM, Cardenas J, Gage C, Meyer DE, Cox C, Wade CE, Cotton BA. Hypofibrinogenemia following injury in 186 children and adolescents: identification of the phenotype, current outcomes, and potential for intervention. Trauma Surg Acute Care Open 2023; 8:e001108. [PMID: 38020863 PMCID: PMC10649809 DOI: 10.1136/tsaco-2023-001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Recent studies evaluating fibrinogen replacement in trauma, along with newly available fibrinogen-based products, has led to an increase in debate on where products such as cryoprecipitate belong in our resuscitation strategies. We set out to define the phenotype and outcomes of those with hypofibrinogenemia and evaluate whether fibrinogen replacement should have a role in the initial administration of massive transfusion. Methods All patients <18 years of age presenting to our trauma center 11/17-4/21 were reviewed. We then evaluated all patients who received emergency-release and massive transfusion protocol (MTP) products. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen <150 or rapid thrombelastography (r-TEG) angle <60 degrees. Our analysis sought to define risk factors for presenting with HYPOFIB, the impact on outcomes, and whether early replacement improved mortality. Results 4169 patients were entered into the trauma registry, with 926 level 1 trauma activations, of which 186 patients received emergency-release blood products during this time; 1%, 3%, and 10% were HYPOFIB, respectively. Of the 186 patients of interest, 18 were HYPOFIB and 168 were non-HYPOFIB. The HYPOFIB patients were significantly younger, had lower field and arrival Glasgow Coma Scale, had higher head Abbreviated Injury Scale, arrived with worse global coagulopathy, and died from brain injury. Non-HYPOFIB patients were more likely to have (+)focused assessment for the sonography of trauma on arrival, sustained severe abdominal injuries, and die from hemorrhage. 12% of patients who received early cryoprecipitate (0-2 hours) had higher mortality by univariate analysis (55% vs 31%, p=0.045), but no difference on multivariate analysis (OR 0.36, 95% CI 0.07 to 1.81, p=0.221). Those receiving early cryoprecipitate who survived after pediatric intensive care unit (PICU) admission had lower PICU fibrinogen and r-TEG alpha-angle values. Conclusion In pediatric trauma, patients with hypofibrinogenemia on admission are most likely younger and to have sustained severe brain injury, with an associated mortality of over 80%. Given the absence of bleeding-related deaths in HYPOFIB patients, this study does not provide evidence for the empiric use of cryoprecipitate in the initial administration of a massive transfusion protocol. Level of Evidence Level III - Therapeutic/Care Management.
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Affiliation(s)
- Justin Gerard
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jan-Michael Van Gent
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jessica Cardenas
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christian Gage
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David E Meyer
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charles Cox
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charles E Wade
- Surgery/Center for Injury Research, The University of Texas Health Science Center McGovern School of Medicine, Houston, Texas, USA
| | - Bryan A Cotton
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, 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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Misirlioglu M, Ekinci F, Yildizdas D, Horoz OO, Yilmaz HL, Incecik F, Ozsoy M, Yontem A, Bilen S, Silay S. A Retrospective Cohort Study of Traumatic Brain Injury in Children: A Single-Institution Experience and Determinants of Neurologic Outcome. J Crit Care Med (Targu Mures) 2023; 9:252-261. [PMID: 37969881 PMCID: PMC10644296 DOI: 10.2478/jccm-2023-0027] [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] [Received: 06/17/2023] [Accepted: 09/19/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) has become a significant cause of death and morbidity in childhood since the elucidation of infectious causes within the last century. Mortality rates in this population decreased over time due to developments in technology and effective treatment modalities. Aim of the study This retrospective cohort study aimed to describe the volume, severity and mechanism of all hospital-admitted pediatric TBI patients at a university hospital over a 5-year period. Material and Methods This was a single-center, retrospective cohort study including 90 pediatric patients with TBI admitted to a tertiary care PICU. The patients' demographic data, injury mechanisms, disease and trauma severity scores, initiation of enteral nutrition and outcome measures such as hospital stay, PICU stay, duration of mechanical ventilation, mortality, and Glasgow Outcome Scale (GOS) were also recorded. Late enteral nutrition was defined as initiation of enteral feeding after 48 hours of hospitalization. Results Of the 90 patients included in the cohort, 60% had mild TBI, 21.1% had moderate TBI and 18.9% had severe TBI. Their mean age was 69 months (3-210 months). TBI was isolated in 34 (37.8%) patients and observed as a part of multisystemic trauma in 56 (62.2%). The most commonly involved site in multisystemic injury was the thorax (33.3%). The length of hospitalization in the late enteral nutrition group was significantly higher than that in the early nutrition group, while the PICU stay was not significantly different between the two groups. The multiple logistic regression analysis found a significant relationship between GOS-3rd month and PIM3 score, the presence of diffuse axonal injury and the need for CPR in the first 24 h of hospitalization. Conclusion Although our study showed that delayed enteral nutrition did not affect neurologic outcome, it may lead to prolonged hospitalization and increased hospital costs. High PIM3 scores and diffuse axonal injury are both associated with worse neurologic outcomes.
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Affiliation(s)
- Merve Misirlioglu
- Department of Pediatric Intensive Care, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hayri Levent Yilmaz
- Department of Pediatric Emergency, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Faruk Incecik
- Department of Pediatric Neurology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Mazhar Ozsoy
- Department of Neurosurgery, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Yontem
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Sevcan Bilen
- Department of Pediatric Emergency, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Sena Silay
- Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
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Gowen AM, Yi J, Stauch K, Miles L, Srinivasan S, Odegaard K, Pendyala G, Yelamanchili SV. In utero and post-natal opioid exposure followed by mild traumatic brain injury contributes to cortical neuroinflammation, mitochondrial dysfunction, and behavioral deficits in juvenile rats. Brain Behav Immun Health 2023; 32:100669. [PMID: 37588011 PMCID: PMC10425912 DOI: 10.1016/j.bbih.2023.100669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/18/2023] Open
Abstract
Maternal opioid use poses a significant health concern not just to the expectant mother but also to the fetus. Notably, increasing numbers of children born suffering from neonatal opioid withdrawal syndrome (NOWS) further compounds the crisis. While epidemiological research has shown the heightened risk factors associated with NOWS, little research has investigated what molecular mechanisms underly the vulnerabilities these children carry throughout development and into later life. To understand the implications of in utero and post-natal opioid exposure on the developing brain, we sought to assess the response to one of the most common pediatric injuries: minor traumatic brain injury (mTBI). Using a rat model of in utero and post-natal oxycodone (IUO) exposure and a low force weight drop model of mTBI, we show that not only neonatal opioid exposure significantly affects neuroinflammation, brain metabolites, synaptic proteome, mitochondrial function, and altered behavior in juvenile rats, but also, in conjunction with mTBI these aberrations are further exacerbated. Specifically, we observed long term metabolic dysregulation, neuroinflammation, alterations in synaptic mitochondria, and impaired behavior were impacted severely by mTBI. Our research highlights the specific vulnerability caused by IUO exposure to a secondary stressor such as later life brain injury. In summary, we present a comprehensive study to highlight the damaging effects of prenatal opioid abuse in conjunction with mild brain injury on the developing brain.
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Affiliation(s)
- Austin M. Gowen
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jina Yi
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kelly Stauch
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Luke Miles
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Sanjay Srinivasan
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Biological Sciences, University of Nebraska at Omaha, Omaha, NE, USA
| | - Katherine Odegaard
- Department of Biological Sciences, Florida State University, Tallahassee, FL, USA
| | - Gurudutt Pendyala
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Genetics, Cell Biology and Anatomy, UNMC, Omaha, NE, 68198, USA
- Child Health Research Institute, Omaha, NE, 68198, USA
- National Strategic Research Institute, UNMC, Omaha, NE, USA
| | - Sowmya V. Yelamanchili
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Genetics, Cell Biology and Anatomy, UNMC, Omaha, NE, 68198, USA
- National Strategic Research Institute, UNMC, Omaha, NE, USA
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46
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Lin WY, Wu KH, Chen CY, Guo BC, Chang YJ, Lee TA, Lin MJ, Wu HP. Stem Cell Therapy in Children with Traumatic Brain Injury. Int J Mol Sci 2023; 24:14706. [PMID: 37834152 PMCID: PMC10573043 DOI: 10.3390/ijms241914706] [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: 08/31/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Pediatric traumatic brain injury is a cause of major mortality, and resultant neurological sequelae areassociated with long-term morbidity. Increasing studies have revealed stem cell therapy to be a potential new treatment. However, much work is still required to clarify the mechanism of action of effective stem cell therapy, type of stem cell therapy, optimal timing of therapy initiation, combination of cocurrent medical treatment and patient selection criteria. This paper will focus on stem cell therapy in children with traumatic brain injury.
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Affiliation(s)
- Wen-Ya Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tung’s Taichung MetroHarbor Hospital, Taichung 433, Taiwan;
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 79-9, Taiwan
| | - Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Tai-An Lee
- Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan;
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 427413, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
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Fang J, Tan TX, Ferron E, Ge LJ. Age predicts likelihood for surgery for pediatric tbi: an analysis of 1745 hospitlizations from a Chinese Children's Hospital. Childs Nerv Syst 2023; 39:2487-2492. [PMID: 37145308 DOI: 10.1007/s00381-023-05975-4] [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: 01/19/2023] [Accepted: 04/29/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE We tested the role of age and sex in surgery following pediatric TBI hospitalization. METHODS Records of 1745 children hospitalized at a pediatric neurotrauma center in China included age, sex, cause of injury, diagnosis of injury, days of hospitalization, in-house rehabilitation, Glasgow Coma Scale score, mortality, 6-month post-discharge Glasgow Outcome Scale score, and surgery intervention. The children were 0-13 years (M= 3.56 years; SD = 3.06), with 47.4% 0-2 years of age. RESULTS The mortality rate was 1.49%. Logistic regression on 1027 children with epidural hematoma, subdural hematoma, intracerebral hemorrhage, and intraventricular hemorrhage showed that controlling for other variables, the odds for younger children to receive surgery was statistically lower for epidural hematomas (OR = 0.75; 95% CI = 0.68-0.82), subdural hematomas (OR = 0.59; 95% CI = 0.47-0.74), and intraventricular hemorrhage (OR = 0.52; 95% CI = 0.28-0.98). CONCLUSIONS While severity of TBI and type of TBI were expected predictors for surgery, a younger age also predicted a significantly lower likelihood of surgery in our sample. Sex of the child was unrelated to surgical intervention.
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Affiliation(s)
- Jiangshun Fang
- Department of Pediatric Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Tony Xing Tan
- Department of Educational and Psychological Studies, University of South Florida, Tampa, Florida, US.
| | - Emily Ferron
- Department of Psychology, Columbia University, NYC, NY, US
| | - Le Jun Ge
- Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, Zhejiang, China
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Jenkin T, D'Cruz K, Anderson V, Scheinberg A, Knight S. Family-centred service in paediatric acquired brain injury rehabilitation: perspectives of children and adolescents and their families. Disabil Rehabil 2023; 45:3087-3098. [PMID: 36106758 DOI: 10.1080/09638288.2022.2121864] [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: 01/30/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Family-centred service is considered best practice in paediatric acquired brain injury (ABI) rehabilitation. However, there is no universal model to guide clinicians and services in implementing this approach with a lack of research evidence informed by the lived experience of families. This study explored experiences of family-centred service during rehabilitation from the perspectives of parents/caregivers, siblings, and children/adolescents with ABI. MATERIALS AND METHODS Semi-structured interviews were conducted with participants from eight families, and included 10 parents/caregivers, five siblings, and four children/adolescents with moderate to severe ABI. Interview transcripts and additional data were analysed using constructivist grounded theory methods. RESULTS Two themes and five sub-themes were developed: (1) Working together as a team: Valuing clinicians' expert knowledge; Doing rehabilitation together; and Sharing family knowledge; and (2) Navigating rehabilitation as a family: Recognising family needs; Juggling family life; and Making rehabilitation work for the family. Participants reflected on the centrality of the child/adolescent with ABI during rehabilitation, and the ways that family needs, life, and involvement in rehabilitation change over time. CONCLUSIONS These findings highlight the importance of clinicians actively seeking to understand families' unique contexts, needs, and priorities during rehabilitation through two-way information sharing with families. Through developing a greater understanding of families' unique contexts, clinicians can be better placed to tailor rehabilitation according to their unique circumstances and needs.Implications for rehabilitationRehabilitation involves active collaboration between families and clinicians that is responsive to changing needs over time.Family involvement in rehabilitation is shaped by family life, and families have unique needs following paediatric acquired brain injury.It is important that clinicians strive to develop an understanding of families' unique needs, values, preferences, and lives to determine how to best support and involve them in rehabilitation.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Kate D'Cruz
- Discipline of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Psychology Service, Royal Children's Hospital, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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49
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Hill E, Whitworth A, Boyes M, Claessen M. An international survey of assessment and treatment practice for discourse in paediatric Acquired Brain Injury. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:577-588. [PMID: 35642559 DOI: 10.1080/17549507.2022.2079724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Guidelines recommend routine discourse assessment and treatment in paediatric acquired brain injury (ABI) but provide little guidance for clinical practice. The degree to which this has influenced the nature of discourse assessment and treatment in clinical practice has not been examined in detail. METHOD Speech-language pathologists working in paediatric ABI (clients aged <18 years) in Australia, New Zealand, the UK, the USA, Canada, and the Asia Pacific region were invited to complete a survey of discourse assessment and intervention practices (n = 77). RESULT Clinicians from Australia and New Zealand comprised over half of a responses (53%). The largest proportion had over 10 years' experience (60%), worked in the metropolitan area (58%), and with secondary school-age children (64%). Routine discourse assessment was undertaken by 80% of respondents, focussing on a limited range of genres. No preferred intervention approach was identified. One-quarter of clinicians routinely considered holistic factors during clinical decision-making. Limited normative data and treatment evidence, insufficient time and training were identified as clinical barriers. CONCLUSION Assessment practices were consistent with guidelines, yet interventions were highly variable, reflecting limited evidence, client heterogeneity, time constraints, and limited training. A biopsychosocial approach to practice was evident, yet a focus on impairment level factors was prominent. Findings support the need for standardised discourse assessment and discourse intervention methods. Translation into practice guidelines would promote consistency and confidence in clinical practice.
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Affiliation(s)
- Elizabeth Hill
- Curtin School of Allied Health, Curtin University, Perth, Western Australia
| | - Anne Whitworth
- College of Health and Medicine, University of Tasmania, Launceston, Tasmania, and
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Western Australia
| | - Mary Claessen
- Curtin School of Allied Health, Curtin University, Perth, Western Australia
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50
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Rezakhah A, Kobets AJ, Emami Sigaroudi F, Mahdkhah A, Barshan J, Gharajedaghi A, Naseri Alavi SA. Correlation Between Clinical Findings at Admission and Glasgow Outcome Scale Score in Children with Traumatic Brain Injury. World Neurosurg 2023; 175:e1300-e1306. [PMID: 37164212 DOI: 10.1016/j.wneu.2023.04.121] [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: 12/28/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Traumatic brain injury has different pathophysiology and outcomes in children and adults. This study investigated the relationship between clinical and laboratory findings at admission and Glasgow Outcome Scale (GOS) score in children with traumatic brain injury. METHODS This prospective cross-sectional single-center study enrolled 444 children 1-16 years old admitted to the neurosurgery ward from 2016 to 2020. Clinical data and laboratory information were extracted from the records of these patients at admission, and the relationship with GOS score at discharge was investigated. RESULTS The 444 patients include 249 (56.08%) boys and 195 (43.92%) girls with a mean age of 7.32 ± 4.4 years. There was no correlation between GOS score and sex (P = 0.12), age (P = 0.16), serum potassium level (P = 0.08), platelet level (P = 0.21), and blood glucose (P = 0.18). There was a significant relationship between GOS score and hypotension (P = 0.03), hyponatremia (P = 0.04), prothrombin time (P = 0.03), partial thromboplastin time (P = 0.03), pupil size (P = 0.02), pupil reaction to light (P = 0.04), and Glasgow Coma Scale score (P = 0.04). CONCLUSIONS Clinical and laboratory findings such as hypotension, hyponatremia, prothrombin time, partial thromboplastin time, pupil size, pupil reaction to light, and Glasgow Coma Scale score at admission could affect GOS score at discharge and result in poor outcomes in children with traumatic brain injury.
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Affiliation(s)
- Amir Rezakhah
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Andrew J Kobets
- Department of Neurological Surgery, Montefiore Medical, Bronx, New York, USA
| | | | - Ata Mahdkhah
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Jalal Barshan
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Gharajedaghi
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran
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