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Şahin S, Botan E, Gün E, Yüksel MF, Süt NY, Kartal AT, Gurbanov A, Kahveci F, Özen H, Havan M, Yıldırım M, Şahap SK, Bektaş Ö, Teber S, Fitoz S, Kendirli T. Correlation between early computed tomography findings and neurological outcome in pediatric traumatic brain injury patients. Neurol Sci 2024:10.1007/s10072-024-07511-x. [PMID: 38622450 DOI: 10.1007/s10072-024-07511-x] [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: 01/11/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Head computed tomography (CT) is frequently utilized for evaluating trauma-related characteristics, selecting treatment options, and monitoring complications in the early stages. This study assessed the relationship between cranial CT findings and early and late neurological outcomes in pediatric TBI patients admitted to the pediatric intensive care unit (PICU). The study included children aged 1 month to 18 years who were admitted to the PICU due to TBI between 2014 and 2020. Sociodemographic data, clinical characteristics, and cranial CT findings were analyzed. Patients were categorized based on their Glasgow Coma Scale (GCS) score. Of the 129 patients, 83 (64%) were male, and 46 (36%) were female, with a mean age of 6.8 years. Falls (n = 51, 39.5%) and in-vehicle traffic accidents (n = 35, 27.1%) were the most common trauma types observed. Normal brain imaging findings were found in 62.7% of the patients, while 37.3% exhibited intracranial pathology. Hemorrhage was the most frequent CT finding. Severe TBI (n = 26, p = 0.032) and mortality (n = 9, p = 0.017) were more prevalent in traffic accidents. The overall mortality rate in the study population was 10.1%. In children with TBI, cranial CT imaging serves as an essential initial method for patients with neurological manifestations. Particularly, a GCS score of ≤ 8, multiple hemorrhages, diffuse cerebral edema, and intraventricular bleeding are associated with sequelae and mortality.
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Affiliation(s)
- Süleyman Şahin
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey.
| | - Edin Botan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Feyza Yüksel
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Nurşah Yeniay Süt
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ayşe Tuğba Kartal
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Seda Kaynak Şahap
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Suat Fitoz
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
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2
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Sekar A, Datta D, Patnaik A. Rotterdam CT Score as a Predictor of Surgical Outcome in Children with Traumatic Brain Injury. Indian J Pediatr 2024; 91:90. [PMID: 37610686 DOI: 10.1007/s12098-023-04837-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Arunkumar Sekar
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India.
| | - Debajyoti Datta
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Ashis Patnaik
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
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Olsen M, Vik A, Lien E, Schirmer-Mikalsen K, Fredriksli O, Follestad T, Sandrød O, Finnanger TG, Skandsen T. A population-based study of global outcome after moderate to severe traumatic brain injury in children and adolescents. J Neurosurg Pediatr 2022; 29:397-406. [PMID: 35061977 DOI: 10.3171/2021.11.peds21285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary aim of this study was to evaluate the global outcome longitudinally over 5 years in children and adolescents surviving moderate to severe traumatic brain injury (msTBI) to investigate changes in outcome over time. The secondary aim was to explore how age at the time of injury affected outcome. METHODS All children and adolescents (aged 0-17 years; subdivided into children aged 0-10 years and adolescents aged 11-17 years) with moderate (Glasgow Coma Scale [GCS] score 9-13) or severe (GCS score ≤ 8) TBI who were admitted to a level I trauma center in Norway over a 10-year period (2004-2014) were prospectively included. In addition, young adults (aged 18-24 years) with msTBI were included for comparison. Outcome was assessed with the Glasgow Outcome Scale-Extended (GOS-E) at 6 months, 12 months, and 5 years after injury. The effect of time since injury and age at injury on the probability of good outcome was estimated by the method of generalized estimating equations. RESULTS A total of 30 children, 39 adolescents, and 97 young adults were included, among which 24 children, 38 adolescents, and 76 young adults survived and were planned for follow-up. In-hospital mortality from TBI was 7% for children, 3% for adolescents, and 18% for young adults. In surviving patients at the 5-year follow-up, good recovery (GOS-E score 7 or 8) was observed in 87% of children and all adolescents with moderate TBI, as well as in 44% of children and 59% of adolescents with severe TBI. No patient remained in a persistent vegetative state. For all patients, the odds for good recovery increased from 6 to 12 months (OR 1.79, 95% CI 1.15-2.80; p = 0.010), although not from 12 months to 5 years (OR 0.98, 95% CI 0.62-1.55; p = 0.940). Children/adolescents (aged 0-17 years) had higher odds for good recovery than young adults (OR 2.86, 95% CI 1.26-6.48; p = 0.012). CONCLUSIONS In this population-based study of pediatric msTBI, surprisingly high rates of good recovery over 5 years were found, including good recovery for a large majority of children and all adolescents with moderate TBI. Less than half of the children and more than half of the adolescents with severe TBI had good outcomes. The odds for good recovery increased from 6 to 12 months and were higher in children/adolescents (aged 0-17 years) than in young adults.
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Affiliation(s)
- Mari Olsen
- 1Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital.,2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU
| | - Anne Vik
- 2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU.,3Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital
| | - Espen Lien
- 4Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital
| | - Kari Schirmer-Mikalsen
- 5Department of Anaesthesiology and Intensive Care, St. Olavs Hospital, Trondheim University Hospital; and
| | - Oddrun Fredriksli
- 2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU.,3Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital
| | - Turid Follestad
- 6Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Oddrun Sandrød
- 5Department of Anaesthesiology and Intensive Care, St. Olavs Hospital, Trondheim University Hospital; and
| | - Torun G Finnanger
- 4Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital
| | - Toril Skandsen
- 1Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital.,2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU
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Hershkovitz Y, Kessel B, Dubose JJ, Peleg K, Zilbermints V, Jeroukhimov I, Givon A, Dudkiewicz M, Aranovich D. Is Diffuse Axonal Injury Different in Adults and Children? An Analysis of National Trauma Database. Pediatr Emerg Care 2022; 38:62-64. [PMID: 35100742 DOI: 10.1097/pec.0000000000002626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Diffuse axonal injury (DAI) is typically associated with significant mechanisms of injury and the effects of acceleration-deceleration forces on brain tissues. The prognosis of DAI remains a matter of active investigation, but little is known about outcome differences between adult and pediatric populations with DAI. METHODS We performed a retrospective cohort study involving blunt trauma patients with DAI between the years 1997 and 2018 from the Israeli National Trauma Registry. The patients were divided to pediatric (age <15 years) and adult (age >15 years) groups, with subsequent comparison of demographics and outcomes. RESULTS Diffuse axonal injury was identified in 1983 patients, including 469 pediatric victims (23.6%) and 1514 adults (76.4%). Adults had higher Injury Severity Score (20.5% vs 13.2%, P = 0.0004), increased mortality (17.7% vs 13.4%, P < 0.0001), longer hospitalizations (58.4% vs 44.4%, P < 0.001), and higher rehabilitation need rates (56.4% vs 41.8%, P < 0.0001). Associated extracranial injuries were also more common in adults, particularly to the chest. CONCLUSIONS Pediatric patients with DAI have improved outcomes and fewer associated injuries than adult counterparts.
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Affiliation(s)
- Yehuda Hershkovitz
- From the Department of Surgery, Shamir Medical Center, Zeriffin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Boris Kessel
- Surgical Division, Hillel Yaffe Medical Center, Hadera, affiliated with Rappoport Medical School, Technion, Haifa
| | - J J Dubose
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Kobi Peleg
- University of Maryland School of Medicine, Baltimore, MD
| | - Viacheslav Zilbermints
- Surgical Division, Hillel Yaffe Medical Center, Hadera, affiliated with Rappoport Medical School, Technion, Haifa
| | - Igor Jeroukhimov
- From the Department of Surgery, Shamir Medical Center, Zeriffin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Adi Givon
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | | | - David Aranovich
- Surgical Division, Hillel Yaffe Medical Center, Hadera, affiliated with Rappoport Medical School, Technion, Haifa
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Madaan P, Gupta D, Agrawal D, Kumar A, Jauhari P, Chakrabarty B, Sharma S, Pandey RM, Paul VK, Misra MC, Gulati S. Neurocognitive Outcomes and Their Diffusion Tensor Imaging Correlates in Children With Mild Traumatic Brain Injury. J Child Neurol 2021; 36:664-672. [PMID: 33624545 DOI: 10.1177/0883073821996095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study aimed to assess the neurocognitive outcomes and their diffusion tensor imaging correlates in children (aged 6-16 years) with mild traumatic brain injury. This prospective analysis included 74 children with mild traumatic brain injury (52 boys; mean age: 9.5 [±2.7] years). Wechsler Intelligence Scale for Children-Indian adaptation (WISC-IV), Child Behavior Checklist, and Children's Sleep Habits Questionnaire were administered for 57 cases (at 3 months postinjury) and 51 controls of similar age. The findings of diffusion tensor imaging (done within 7 days of injury) were correlated with various WISC-IV indices. The presenting features at the time of injury were loss of consciousness (53%), confusion or disorientation (47%), and post-traumatic amnesia (10%). Other features in the acute phase included drowsiness (86%), headache (78%), balance problems (62%), nausea (47%), fatigue (45%), vomiting (35%), nasal or ear bleed (12%), sensitivity to sound and light (12%), etc. At 3 months postinjury, the children with mild traumatic brain injury performed poorly in terms of Intelligence Quotient, perceptual reasoning index, and processing speed index as compared to controls. Based on the Child Behavior Checklist, 17% of children with mild traumatic brain injury had internalizing behavioral problems in comparison with 4% of controls. Prevalence of poor sleepers in the mild traumatic brain injury cohort and controls was 12.3% and 2% respectively. Headache, reduced attention span, and fatigue were common postconcussion symptoms. There was a positive correlation between right uncinate fasciculus fractional anisotropy and verbal comprehension index (r = 0.32; P < .05).
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Affiliation(s)
- Priyanka Madaan
- Child Neurology Division, Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Department of Pediatrics, 29751All India Institute of Medical Sciences, New Delhi, India.,Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Gupta
- Department of Neurosurgery, 29751All India Institute of Medical Sciences and Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, 29751All India Institute of Medical Sciences and Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, 29751All India Institute of Medical Sciences and Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Department of Pediatrics, 29751All India Institute of Medical Sciences, New Delhi, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Department of Pediatrics, 29751All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Sharma
- Child Neurology Division, Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Department of Pediatrics, 29751All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, 29751All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K Paul
- Department of Pediatrics, 29751All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C Misra
- Department of General Surgery, 29751All India Institute of Medical Sciences and Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
| | - Sheffali Gulati
- Child Neurology Division, Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Department of Pediatrics, 29751All India Institute of Medical Sciences, New Delhi, India
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6
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Traumatic Brain Injury-Related Pediatric Mortality and Morbidity in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2021; 153:109-130.e23. [PMID: 34166832 DOI: 10.1016/j.wneu.2021.06.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of pediatric traumatic brain injury (pTBI) in low- and middle-income countries (LMICs) is unknown. To fill this gap, we conducted a review that aimed to characterize the causes of pTBI in LMICs, and their reported associated mortality and morbidity. METHODS A systematic review was conducted. MEDLINE, Embase, Global Health, and Global Index Medicus were searched from January 2000 to May 2020. Observational or experimental studies on pTBI of individuals aged between 0 and 16 years in LMICs were included. The causes of pTBI and morbidity data were descriptively analyzed, and case fatality rates were calculated. PROSPERO ID CRD42020171276. RESULTS A total of 136 studies were included. Fifty-seven studies were at high risk of bias. Of the remaining studies, 170,224 cases of pTBI were reported in 32 LMICs. The odds of having a pTBI were 1.8 times higher (95% confidence interval, 1.6-2.0) in males. The odds of a pTBI being mild were 4.4 times higher (95% confidence interval, 1.9-6.8) than a pTBI being moderate or severe. Road traffic accidents were the most common cause (n = 16,275/41,979; 39%) of pTBIs. On discharge, 24% of patients (n = 4385/17,930) had a reduction in their normal mental or physical function. The median case fatality rate was 7.3 (interquartile range, 2.1-7.7). CONCLUSIONS Less than a quarter (n = 32) of all LMICs have published high-quality data on the volume and burden of pTBI. From the limited data available, young male children are at a high risk of pTBIs in LMICs, particularly after road traffic accidents.
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Madaan P, Agrawal D, Gupta D, Kumar A, Jauhari P, Chakrabarty B, Pandey RM, Paul VK, Misra MC, Gulati S. Clinicoepidemiologic Profile of Pediatric Traumatic Brain Injury: Experience of a Tertiary Care Hospital From Northern India. J Child Neurol 2020; 35:970-974. [PMID: 32748676 DOI: 10.1177/0883073820944040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic brain injury is an important cause of acquired brain injury. The current study brings to light the clinicoepidemiologic profile of pediatric traumatic brain injury in India. Retrospective record analysis of children (aged ≤ 16 years) with traumatic brain injury presenting to an apex-trauma-center in North India over 4 years was done. Of more than 15 000 patients with a suspected head injury, 4833 were children ≤16 years old. Of these, 1074 were admitted to the inpatient department; 65% were boys with a mean age at presentation being 6.6 years. Most patients (85%) had a Glasgow Coma Scale score of 13 to 15 at presentation while Glasgow Coma Scale scores of ≤8 was seen in 10% of patients. Neuroimaging (computed tomography [CT]) abnormalities were seen in 12% of patients, with the commonest abnormality being skull fracture, followed by contusions, and extradural hemorrhage. Around 2% of patients required decompressive craniotomy whereas 3% of patients succumbed to their illness.Among the inpatients with pediatric traumatic brain injury, two-thirds were boys with a mean age at presentation of 7.6 years. Severity of traumatic brain injury varied as mild (64%), moderate (11%), and severe (25%). The most common mode of injury was accidental falls (59%) followed by road traffic and rail accidents (34%). Neuroimaging abnormalities were seen in half of inpatients with pediatric traumatic brain injury, with the commonest abnormality being skull fracture. Pediatric head injuries are an important public health problem and constitute a third of all head injuries. They are more common in boys, and the most common modes of injury are accidental falls, followed by road traffic accidents.
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Affiliation(s)
- Priyanka Madaan
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak Agrawal
- Department of Neurosurgery, 28730AIIMS, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, 28730AIIMS, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, 28730AIIMS, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R M Pandey
- Department of Biostatistics, 28730AIIMS, New Delhi, India
| | | | - M C Misra
- Department of General Surgery, 28730AIIMS, New Delhi, India
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India
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8
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Bedry T, Tadele H. Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study. Emerg Med Int 2020; 2020:1965231. [PMID: 32399303 PMCID: PMC7204112 DOI: 10.1155/2020/1965231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is the most common cause of death/disability in children. The Glasgow coma scale and other parameters are used for treatment/follow-up of TBI. Childhood TBI data are scarce from sub-Saharan Africa. The study aimed to determine the pattern and predictors of the TBI outcome in Southern Ethiopia. METHODS An observational cross-sectional study was conducted from September 2017 to September 2018 at Hawassa University Hospital. Structured questionnaires were used for data collection. Significant associations were declared at a P value of <0.05. RESULTS There were 4,258 emergency room (ER) visits during the study period, and TBI contributed to 317 (7.4%) cases. The mean age of study subjects was 7.66 ± 3.88 years. Boys, predominantly above 5 years of age, comprise 218 (68.8%) of the study subjects with a male to female ratio of 2.2 : 1. Pedestrian road traffic accidents (RTA), 120 (37.9%), and falls, 104 (32.8%), were the commonest causes of TBI. Mild, moderate, and severe TBI were documented in 231 (72.9%), 61 (19.2%), and 25 (7.9%) of cases, respectively. Most of the TBI cases presented within 24 hrs of injury, 258 (81.4%). Recovery with no neurologic deficit, 267 (84.2%); focal neurologic deficit, 30 (9.5%); depressed mentation, 10 (3.2%); and death, 10 (3.2%), were documented. Signs of increased intracranial pressure (ICP) at admission [AOR: 1.415 (95% CI: 1.4058-9.557)], severe TBI [AOR: 2.553 (95% CI: 1.965-4.524)], presence of hyperglycemia [AOR: 2.318 (95% CI: 1.873-7.874)], and presence of contusion, diffuse axonal injury (DAI), or intracranial bleeding on the head computed tomography (CT) scan [AOR: 2.45 (95% CI: 1.811-7.952)] predicted poor TBI outcome. CONCLUSION TBI contributed to 7.4% of pediatric ER visits. Pedestrian RTA and falls, early presentation (<24 hours of injury), and mild form of TBI among boys were the most common documented patterns. ICP, hyperglycemia, severe TBI, and presence of contusion, DAI, or intracranial bleeding on head CT predicted poor outcome. Strategies to ensure road safety and to prevent falls and animal-related injuries and TBI follow-up for ICP and glycemic controls are recommended.
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Affiliation(s)
- Tuji Bedry
- Department of Pediatrics and Child Health, College of Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Henok Tadele
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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9
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Iyer S, Patel G. Study of risk factors, clinical spectrum, and outcome for head injury in pediatric age group in Western India. Afr J Paediatr Surg 2020; 17:26-32. [PMID: 33106450 PMCID: PMC7818666 DOI: 10.4103/ajps.ajps_2_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM To study various risk factors which leads to head injury, severity of head injury and to compare survival as predicted by the Revised Trauma Score (RTS) and Pediatric Trauma Score (PTS) in pediatric patients admitted in a tertiary care hospital. METHODS 300 consecutive pediatric patients below 12 years of age with head injury admitted in our institute were analysed as per a set proforma. Data pertaining to patient's demographic details, mode of injury, computed tomography (CT) findings, type of management, severity of head injury, and outcome were recorded. The results were tabulated and analyzed. RTS and PTS scores were calculated to predict the survival of an individual patient. RESULTS The most commonly affected age group was 1-5 years. Boys outnumbered girls in the incidence. Fall was the most common injury, with road traffic accident being the most common cause of mortality. Skull fracture was the most common CT scan finding. Most of the patients presented with mild head injury (Glasgow Coma Scale 13-15), and they improved with conservative management only. RTS and PTS scores were calculated and were equally effective in predicting the outcome for a particular patient. CONCLUSION Head injury occurs more commonly in 1-5 years' age group due to fall from unprotected roof tops. The overall prognosis in majority of the cases is excellent. However, road traffic accident shows the highest mortality and hence, we propose to include mode of injury as a variable for designing future predictive outcome models.
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Affiliation(s)
- Sandhya Iyer
- Department of General Surgery, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Gaurav Patel
- Department of General Surgery, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
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Dara PK, Parakh M, Choudhary S, Jangid H, Kumari P, Khichar S. Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan. J Neurosci Rural Pract 2019; 9:226-231. [PMID: 29725174 PMCID: PMC5912029 DOI: 10.4103/jnrp.jnrp_269_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: The aim of this study was to evaluate clinico-radiological profile and outcome of pediatric traumatic brain injury (TBI). Design: Prospective observational study Setting: Intensive Care Unit, ward and OPD of Pediatrics, Dr. S. N. Medical College, Jodhpur (tertiary care hospital). Participants: A total of 188 children (1 month–18 years) were enrolled and 108 admitted. Intervention: TBI classified as mild, moderate, or severe TBI. Neuroimaging was done and managed as per protocol. Demographic profile, mode of transport, and injury were recorded. Outcome: Measured as hospital stay duration, focal deficits, mortality, and effect of early physiotherapy. Results: Males slightly outnumbered females mean age was 5.41 ± 4.20 years. Fall from height was the main cause of TBI (61.11%) followed by road traffic accident (RTA) (27.78%). Majority (56.56%) reached hospital within 6 h of injury, out of which 27% of patients were unconscious. Mild, moderate, and severe grade of TBI was seen in 50%, 27.78%, and 22.22% of cases, respectively. About 12.96% of cases required ventilator support. The average duration of hospital stay was 11.81 ± 12.9 days and was lesser when physiotherapy and rehabilitation were started early. In all children with temporal bone fracture, magnetic resonance imaging (MRI) brain revealed a temporal lobe hematoma and contusion in spite of initial computed tomography (CT) head normal. Children who have cerebrospinal fluid (CSF) rhinorrhea/otorrhea had a high chance of fracture of base of skull and contusion of the basal part of the brain. Conclusion: In India, fall from height is common setting for pediatric TBI besides RTA. Early initiation of physiotherapy results in good outcome. MRI detects basal brain contusions in children presenting with CSF rhinorrhea/otorrhea even if initial CT brain is normal.
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Affiliation(s)
- Pawan Kumar Dara
- Department of Pediatrics, S P Medical College, Bikaner, Rajasthan, India
| | - Manish Parakh
- Department of Pediatrics, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Shyama Choudhary
- Department of Pediatrics, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Hemant Jangid
- Department of Radiodiagnosis, MDM Hospital, Jodhpur, Rajasthan, India
| | - Priyanka Kumari
- Department of Anaesthesia, S P Medical College, Bikaner, Rajasthan, India
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Pal R, Ghosh A, Kumar R, Galwankar S, Paul SK, Pal S, Sinha D, Jaiswal AK, Moscote-Salazar LR, Agrawal A. Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India. J Family Med Prim Care 2019; 8:775-783. [PMID: 31041200 PMCID: PMC6482791 DOI: 10.4103/jfmpc.jfmpc_214_18] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Roads are considered a sign of development bringing colossal benefits to community as socioeconomic and logistic facilitator. Yet, growth of road network has brought road crashes leading to civic pain from premature deaths of productive age group. In 2017, 16 citizens were killed and 53 injured every hour on Indian roads as per officially reported data, while a fair number go unreported. This is unacceptably high when compared with international standards. Risk correlates of road traffic injuries (RTIs) need to be redefined so as to form a continuum with other confounding factors that impact to take lives on road. Risk factors impacting RTIs vary from human components to the roles and responsibilities of healthcare stakeholders. We should have made roads safer for all citizens because a large percentage of population – children, pedestrians, cyclists, motorcyclists, and the elderly – are most vulnerable. A taskforce was set up by the Academy of Family Physicians of India to scientifically analyze the literature available to assess risks and put forward appropriate recommendations.
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Affiliation(s)
- Ranabir Pal
- Department of Community Medicine, Venereology and Leprosy, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Amrita Ghosh
- Department of Biochemistry, Medical College, Kolkata, West Bengal, India
| | - Raman Kumar
- Academy of Family Physicians of India, All India Institute of Medical Sciences, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
| | - Swapan Kumar Paul
- Department of Community Medicine, Venereology and Leprosy, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Shrayan Pal
- Department of Dermatology, Venereology and Leprosy, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Debashis Sinha
- High Court at Calcutta and The Supreme Court of India, All India Institute of Medical Sciences, New Delhi, India
| | - A K Jaiswal
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - Luis Rafael Moscote-Salazar
- Neurosurgery-Critical Care, RED LATINO, Organización Latinoamericana de Trauma y cuidado, Neurointensivo, Bogota, Colombia
| | - Amit Agrawal
- Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
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Eloqayli H, Khader Y, Jamous M, Alqarqaz F, Nasrallah B, Abuchaaban M. Spectrum and Outcome of Moderate Pediatric Head Injury Patients Admitted to Main Tertiary Hospital in Northern Jordan Border Hosting City During Strain Period of Syrian Crises. Open Neurol J 2018. [DOI: 10.2174/1874205x01812010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims and Background:To evaluate and compare Health-Related Quality of Life (HRQoL) and disability outcome in pediatric moderate Traumatic Brain Injury (TBI) according to age, brain CT findings and treatment. The outcome could be different for none-war children in the border hosting community when health system under strain from Syrian crises.Methods:The HRQoL scores of 43 children with moderate TBI and abnormal brain CT, aged 8-12(n=24) and 13-18 (n=19) years at the time of injury were assessed using the Pediatric QOL Inventory, child self-report version (PedsQL). Group I (n=18) is surgically treated compared to group II (n=25) being medically treated. Disability, injury mechanism was compared.Results:Mean (SD) age was 12.2 (3.1) year. Based on treatment, the two groups differed only in the number of admission days (p= 0.009) with no significant difference in mean disability outcome and mean QoL in all domains. Based on age, older children (13-18 year) had better psychosocial health than younger children (8-12 year). Falling down, sport and recreational activity predominate as a mechanism of injury followed by a pedestrian. The acute epidural hematoma was the most common CT scan finding in the operative group (n=17) whereas, contusions were the most common in non-operative.Conclusion:This initial work could enhance research outcome from border hosting community that may suffer strain on the health sector and personal in periods of refugee influx and sudden population increase though they are not directly affected by the conflict crises. Single-incident moderate TBI where the diffuse axonal injury is absent or limited based on injury mechanism and severity has a good long-term outcome in children.
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Chaitanya K, Addanki A, Karambelkar R, Ranjan R. Traumatic brain injury in Indian children. Childs Nerv Syst 2018; 34:1119-1123. [PMID: 29594463 DOI: 10.1007/s00381-018-3784-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) in children and adolescents is a community-based medical and educational challenge world-over due to increasing urbanization and motorization. In India, children between 1 to 15 years constitute significant proportion of the total population, who are vulnerable for TBI. In developed countries, pediatric trauma mortality still represents more than half of all childhood fatalities, which is 18 times more common than brain tumors. In this study, we attempted to analyze epidemiological factors, management, and outcome of TBI in children at a tertiary care center in Pune, Maharashtra. AIM AND OBJECTIVES To study the clinical spectrum of pediatric traumatic brain injury cases received at a Tertiary Care Hospital. MATERIALS AND METHODS This prospective study (August 2015-July 2017), conducted at our institution, includes all children < 16 years with TBI reporting to the neurosurgical emergency department. All the case records were reviewed and the pertinent data (clinical history, age, sex, mode of injury, computed tomography (CT) scan findings, interventions, morbidity, and mortality) analyzed. Any residual neurological deficits at the time discharge were assessed as the outcome of TBI. RESULTS A total 76 pediatric cases of TBI were admitted during the period of August 2015-July 2017, with 51 males (67%) and 25 females (33%) with male to female ratio 2:1. Mean age of incidence in our study is 5.5 years. Out of 76 children with TBI, 60.5% were of mild, 14.5% moderate, and 25% severe TBI. Overall, RTA (40.8%) is the most common mode of injury followed by fall from height (30.2%) and slippage in and around home (26.4%). Clinical evaluation revealed, loss of consciousness(LOC) in 36 (47.3%) patients, vomiting in 42 (55%) patients, headache in 10 (13%) patients, ENT bleeding in 18 (23.6%), and seizure in 16 (21%) patients, no external injuries in 25 (33%) patients, normal sensorium was found in 41 (54%) patients, 18 (23.6%) children were drowsy at presentation, and 17 (22.3%) children were unconscious. CT scan findings revealed no gross abnormality in (26%), extradural heamorrhage (EDH) (18.4%), subdural hemorrhage (SDH) (14.4%), subarachnoid hemorrhage (21%), fracture skull (55.26%), cerebral oedema, and contusion (48.68%) as the radiological injury patterns. Out of 76 children, 42 (55%) children are managed with only observation, 26 (34%) children required only medical pharmacological treatment, and 8 (10.5%) children required surgical intervention, 24, (31.6%) children required mechanical ventilation. Overall mortality is 5.26%. Thus among the survivors (n = 72), 57 (79%) went home with no residual deficit, 3 (4%) had headache, 4 (5.5%) had hemiparesis, 2 (2.7%) had monoparesis, 1 (1.4%) had hypertonia, 3 (4%) had seizures, 2 (2.7%) had hydrocephalus, 2 (2.7%) had facial palsy, 2 (2.7%) had vision impairment, and 2 (2.7%) had speech impairment. In our study, we found that there is a significant association between residual deficits and severity of injury (p = 0.3), there is no significant association between mode of injury and outcome (p = 0.7). Mean duration of stay in hospital was 6.9 days but 60% of patients had stay of less than 5 days. CONCLUSION Most of these injuries are preventable in infancy and childhood by ensuring proper vigilance, tender care by the parents and the caretakers. Safe driving techniques have to be followed by parents while traveling with children in their motor vehicles. Need to focus on grading the severity of TBI rather than on factors like age, mode of injury, and presence or absence of external injuries.
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Affiliation(s)
- Krishna Chaitanya
- Department of Pediatrics and Department of Neuro Surgery, Aditya Birla Memorial Hospital, Pune, Maharashtra, India.
| | - Archana Addanki
- Department of Pediatrics and Department of Neuro Surgery, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Rajendra Karambelkar
- Department of Pediatrics and Department of Neuro Surgery, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Rakesh Ranjan
- Department of Pediatrics and Department of Neuro Surgery, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
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Abdelgadir J, Punchak M, Smith ER, Tarnasky A, Muhindo A, Nickenig Vissoci JR, Haglund MM, Kitya D. Pediatric traumatic brain injury at Mbarara Regional Referral Hospital, Uganda. J Clin Neurosci 2018; 47:79-83. [DOI: 10.1016/j.jocn.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/01/2017] [Indexed: 12/20/2022]
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