An update on pediatric traumatic brain injury

Abstract

Introduction Traumatic brain injury (TBI) remains the commonest neurological and neurosurgical cause of death and survivor disability among children and young adults. This review summarizes some of the important recent publications that have added to our understanding of the condition and advanced clinical practice. Methods Targeted review of the literature on various aspects of paediatric TBI over the last 5 years. Results Recent literature has provided new insights into the burden of paediatric TBI and patient outcome across geographical divides and the severity spectrum. Although CT scans remain a standard, rapid sequence MRI without sedation has been increasingly used in the frontline. Advanced MRI sequences are also being used to better understand pathology and to improve prognostication. Various initiatives in paediatric and adult TBI have contributed regionally and internationally to harmonising research efforts in mild and severe TBI. Emerging data on advanced brain monitoring from paediatric studies and extrapolated from adult studies continues to slowly advance our understanding of its role. There has been growing interest in non-invasive monitoring, although the clinical applications remain somewhat unclear. Contributions of the first large scale comparative effectiveness trial have advanced knowledge, especially for the use of hyperosmolar therapies and cerebrospinal fluid drainage in severe paediatric TBI. Finally, the growth of large and even global networks is a welcome development that addresses the limitations of small sample size and generalizability typical of single-centre studies. Conclusion Publications in recent years have contributed iteratively to progress in understanding paediatric TBI and how best to manage patients.

Variables included in cerebral palsy registries globally: A scoping review

“…A targeted literature review by Figati concluded that traumatic brain injury is still an important cause of disability. 35 Even though this review classified perinatal risk factors as an additional CP variable, we recommend that perinatal and postnatal CP risk factors be included as core variables in an LMIC CP registry, because the preliminary data suggest that they constitute an important proportion of aetiological risk for CP in LMICs. The main reason for these variables being classified as additional ones in this review was because fewer studies from LMICs were included in it.…”

“…33,34 Second, tuberculous meningitis is also presumed to be an important contributor to postnatal CP in South Africa. 35 Third, traumatic brain injury remains an important postnatal cause of CP in many LMICs. A targeted literature review by Figati concluded that traumatic brain injury is still an important cause of disability.…”

Spectrum of Magnetic Resonance Imaging Findings in Acute Pediatric Traumatic Brain Injury - A Pictorial Essay

“…If major traumas (as defined by Thompson et al 1 ) are rare in children - accounting for only 6% of all major traumas in both children and adults, 2 pediatric HT is the leading cause of Emergency Department visits worldwide. 3 Whether accidental or not, its effects can be devastating, 4 making it the leading cause of mortality and morbidity in children. 5 , 6 The best imaging tools must be used to evaluate the HT and take suitable measures for each patient.…”

“… 23 Nonetheless, whether obtained on day zero of the HT or a few days later, MRI brings enough details to improve prognostication of long-term neurological outcomes. 4 , 8 , 24 Small hemorrhagic lesions are detected with T2*GRE or SWI sequences. FLAIR sequences have greater sensitivity for non-hemorrhagic lesions, contusions, and vasogenic edema that develop in brainstem and deep brain structures.…”