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Kennedy L, Nuno M, Gurkoff GG, Nosova K, Zwienenberg M. Moderate and severe TBI in children and adolescents: The effects of age, sex, and injury severity on patient outcome 6 months after injury. Front Neurol 2022; 13:741717. [PMID: 35989939 PMCID: PMC9382186 DOI: 10.3389/fneur.2022.741717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
The interaction of age, sex, and outcomes of children with head injury remains incompletely understood and these factors need rigorous evaluation in prognostic models for pediatric head injury. We leveraged our large institutional pediatric TBI population to evaluate age and sex along with a series of predictive factors used in the acute care of injury to describe the response and outcome of children and adolescents with moderate to severe injury. We hypothesized that younger age at injury and male sex would be associated with adverse outcomes and that a novel GCS-based scale incorporating pupillary response (GCS-P) would have superior performance in predicting 6-month outcome. GCS and GCS-P along with established CT scan variables associated with neurologic outcomes were retrospectively reviewed in children (age birth to 18 years) with moderate or severe head injury. GOS-E was prospectively collected 6 months after injury; 570 patients were enrolled in the study, 520 with TBI and 50 with abusive head trauma, each analyzed separately. In the TBI cohort, the median age of patients was 8 years and 42.7% had a severe head injury. Multiple predictors of outcome were identified in univariate analysis; however, based on a multivariate analysis, the GCS was identified as most reliable, outperforming GCS-P, pupil score, and other clinical and CT scan predictors. After stratifying patients for severity of injury by GCS, no age- or sex-related effects were observed in our patient population, except for a trend toward worse outcomes in the neonatal group. Patients with abusive head trauma were more likely to have severe injury on presentation, increased mortality rate, and unfavorable outcome. Additionally, there was clear evidence that secondary injuries, including hypoxia, hypotension, and hypothermia were significantly associated with lower GCS and higher mortality in both AHT and TBI populations. Our findings support the use of GCS to guide clinical decision-making and prognostication in addition to emphasizing the need to stratify head injuries for severity when undertaking outcome studies. Finally, secondary injuries are a clear predictor of poor outcome and how we record and manage these events need to be considered moving forward.
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Affiliation(s)
- Lori Kennedy
- Center for Nursing Science, University of California Davis Health, Sacramento, CA, United States
| | - Miriam Nuno
- Public Health Sciences, Medical Sciences 1-C, University of California, Davis, Davis, CA, United States
| | - Gene G. Gurkoff
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
- Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - Kristin Nosova
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | - Marike Zwienenberg
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
- *Correspondence: Marike Zwienenberg
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Danilov GV, Shifrin MA, Kotik KV, Ishankulov TA, Orlov YN, Kulikov AS, Potapov AA. Artificial Intelligence Technologies in Neurosurgery: a Systematic Literature Review Using Topic Modeling. Part II: Research Objectives and Perspectives. Sovrem Tekhnologii Med 2021; 12:111-118. [PMID: 34796024 PMCID: PMC8596229 DOI: 10.17691/stm2020.12.6.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
The current increase in the number of publications on the use of artificial intelligence (AI) technologies in neurosurgery indicates a new trend in clinical neuroscience. The aim of the study was to conduct a systematic literature review to highlight the main directions and trends in the use of AI in neurosurgery.
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Affiliation(s)
- G V Danilov
- Scientific Board Secretary; N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia; Head of the Laboratory of Biomedical Informatics and Artificial Intelligence; N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
| | - M A Shifrin
- Scientific Consultant, Laboratory of Biomedical Informatics and Artificial Intelligence; N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
| | - K V Kotik
- Physics Engineer, Laboratory of Biomedical Informatics and Artificial Intelligence; N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
| | - T A Ishankulov
- Engineer, Laboratory of Biomedical Informatics and Artificial Intelligence; N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
| | - Yu N Orlov
- Head of the Department of Computational Physics and Kinetic Equations; Keldysh Institute of Applied Mathematics, Russian Academy of Sciences, 4 Miusskaya Sq., Moscow, 125047, Russia
| | - A S Kulikov
- Staff Anesthesiologist; N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
| | - A A Potapov
- Professor, Academician of the Russian Academy of Sciences, Chief Scientific Supervisor N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
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