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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] [What about the content of this article? (0)] [Affiliation(s)] [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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McInnis C, Garcia MJS, Widjaja E, Frndova H, Huyse JV, Guerguerian AM, Oyefiade A, Laughlin S, Raybaud C, Miller E, Tay K, Bigler ED, Dennis M, Fraser DD, Campbell C, Choong K, Dhanani S, Lacroix J, Farrell C, Beauchamp MH, Schachar R, Hutchison JS, Wheeler AL. Magnetic Resonance Imaging Findings Are Associated with Long-Term Global Neurological Function or Death after Traumatic Brain Injury in Critically Ill Children. J Neurotrauma 2021; 38:2407-2418. [PMID: 33787327 DOI: 10.1089/neu.2020.7514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The identification of children with traumatic brain injury (TBI) who are at risk of death or poor global neurological functional outcome remains a challenge. Magnetic resonance imaging (MRI) can detect several brain pathologies that are a result of TBI; however, the types and locations of pathology that are the most predictive remain to be determined. Forty-two critically ill children with TBI were recruited prospectively from pediatric intensive care units at five Canadian children's hospitals. Pathologies detected on subacute phase MRIs included cerebral hematoma, herniation, cerebral laceration, cerebral edema, midline shift, and the presence and location of cerebral contusion or diffuse axonal injury (DAI) in 28 regions of interest were assessed. Global functional outcome or death more than 12 months post-injury was assessed using the Pediatric Cerebral Performance Category score. Linear modeling was employed to evaluate the utility of an MRI composite score for predicting long-term global neurological function or death after injury, and nonlinear Random Forest modeling was used to identify which MRI features have the most predictive utility. A linear predictive model of favorable versus unfavorable long-term outcomes was significantly improved when an MRI composite score was added to clinical variables. Nonlinear Random Forest modeling identified five MRI variables as stable predictors of poor outcomes: presence of herniation, DAI in the parietal lobe, DAI in the subcortical white matter, DAI in the posterior corpus callosum, and cerebral contusion in the anterior temporal lobe. Clinical MRI has prognostic value to identify children with TBI at risk of long-term unfavorable outcomes.
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Affiliation(s)
- Carter McInnis
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - María José Solana Garcia
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Helena Frndova
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Judith Van Huyse
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Adeoye Oyefiade
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne Laughlin
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, and Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charles Raybaud
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elka Miller
- Department of Medical Imaging, and Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Keng Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Erin D Bigler
- Department of Psychological Science and Neuroscience Centre, Brigham Young University, Provo, Utah, USA
| | - Maureen Dennis
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, and University of Toronto, Toronto, Ontario, Canada
| | - Douglas D Fraser
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Schulich School of Medicine University of Western Ontario, Children's Hospital of the London Health Sciences Centre and the Lawson Research Institute, London, Ontario, Canada
| | - Craig Campbell
- Division of Neurology, Children's Hospital of the London Health Sciences Centre and Department of Pediatrics, Epidemiology and Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Karen Choong
- Division of Pediatric Intensive Care, Department of Pediatrics, McMaster Children's Hospital-Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sonny Dhanani
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Catherine Farrell
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Miriam H Beauchamp
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Russell Schachar
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James S Hutchison
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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Li G, Wang F, Otte D, Simms C. Characteristics of pedestrian head injuries observed from real world collision data. Accid Anal Prev 2019; 129:362-366. [PMID: 31130209 DOI: 10.1016/j.aap.2019.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 04/15/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Head injury is one of the most common injury types in vehicle-to-pedestrian collisions, which leads to death and long-term disabilities. However, detailed analysis of pedestrian head injuries in real world collisions is scarce. Thus the current study used two samples of 120 cases and 184 cases extracted from 1060 pedestrian collision cases captured during 2000-2015 from the GIDAS (German In-Depth-Accident Study) database to investigate the detailed characteristics of AIS2+ pedestrian head injuries. Firstly, the interrelationship between different head injury types (skull fracture, focal brain injury, concussion and diffuse axonal injury (DAI)) was analysed using the sample of 120 cases which each had at least one AIS2+ head injury. Then the influences of impact speed, pedestrian age and car front shape parameters on the injury risk of skull fracture, focal brain injury and concussion were assessed using the logistic regression method, based on the sample of 184 AIS1+ cases where the primary head contact location was within the windscreen glass area. The results show that: skull fractures and focal brain injuries dominate for AIS3+ head injuries and are generally associated with each other; concussion is the most important injury type for AIS2 head injuries and usually occurs in isolation. Further, for head impacts to the windscreen glass area a higher bonnet leading edge helps to reduce concussion odds, and none of the selected car front shape parameters are significant for the odds of skull fracture and focal brain injury, and vehicle impact speed and pedestrian age are insignificant for concussion. These detailed characteristics of pedestrian head injuries provide a basis for future pedestrian head injury prevention strategies with skull fractures and focal brain injuries being the most important injuries to address.
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Affiliation(s)
- Guibing Li
- School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, 411201, China
| | - Fang Wang
- School of Mechanical and Automotive Engineering, Xiamen University of Technology, Xiamen 361024, China
| | - Dietmar Otte
- Accident Research Unit, Medical University of Hannover, Hannover, 30625, Germany
| | - Ciaran Simms
- Trinity Centre for Bioengineering, Trinity College Dublin, Ireland.
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Abstract
PURPOSE This is a descriptive study of the annual incidence of brain injuries in motor vehicle crashes by type, seat belt use, and crash severity (delta V) using national accident data. The risk for concussion, diffuse axonal injury (DAI), and severe head injury was determined. METHODS 1994-2011 NASS-CDS was analyzed to estimate the number of brain injuries annually in nonejected adults involved in motor vehicle crashes. Crashes were grouped by front, side, rear, and rollover, and the effect of belt use was investigated. Light vehicles were included with model year 1994+. Head injuries were identified as concussion, DAI, severe head injury (Abbreviated Injury Scale [AIS] 4+), and skull fracture. The annual incidence, risk, and rate for different types of head injury were estimated with standard errors. RESULTS Motor vehicle crashes involved 33,191 ± 7,815 occupants with concussion, 5,665 ± 996 with AIS 4+ head injuries, 986 ± 446 with DAI, and 3,300 ± 531 with skull fracture annually. The risk was 1.64 ± 0.39% for concussion, 0.28 ± 0.05% for severe head injury (AIS 4+), 0.05 ± 0.02% for DAI, and 0.16 ± 0.03% for skull fracture in tow-away crashes. The risk for severe head injury (AIS 4+) was highest in rollovers (0.74 ± 0.16%) and lowest in rear impacts (0.17 ± 0.05%). Head injury risk depended on seat belt use, crash type, and crash severity (delta V). Seat belt use lowered the risk for AIS 4+ head injury by 74.8% and skull fracture by 73.2%. CONCLUSIONS Concussions occur in about one out of 61 occupants in tow-away crashes. The risk was highest in rollover crashes (4.73 ± 1.09%) and it was reduced 69.2% by seat belt use. Severe brain injuries occurred less often and the risk was also reduced by seat belt use.
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