Blood Pressure and Outcome after Severe Pediatric Traumatic Brain Injury

Vavilala, Monica S.; Bowen, Anna; Lam, Arthur M.; Uffman, Joshua C.; Powell, Jill; Winn, H. Richard; Rivara, Frederick P.

doi:10.1097/01.ta.0000101759.23607.57

Cited by 112 publications

(49 citation statements)

References 18 publications

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“…Large prospective randomized clinical trails are essential to compare the efficacy of different strategies [32,37,38,39,40]. These are not easy to perform in children with severe TBI since the number of children treated at each center is low.…”

Section: Discussionmentioning

confidence: 99%

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A twocenter retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.

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Section: Discussionmentioning

confidence: 99%

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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“…Beyond these limits of autoregulation, CBF depends on MAP/CPP; hypotension results in cerebral ischemia, and hypertension causes cerebral hyperemia. Hypotension after pediatric TBI is associated with poor outcome [10][11][12].…”

Section: Cerebral Autoregulationmentioning

confidence: 99%

“…Trauma accounts for 36% of deaths in U.S. children 1-14 years of age [4], and traumatic brain injury (TBI) is the leading cause of pediatric trauma [5]. Low Glasgow Coma Scale score, coagulopathy, hyperglycemia, early hypotension, and impaired cerebral autoregulation are associated with poor outcome after pediatric TBI [6][7][8][9][10][11][12]. In this review, we discuss what we know about CBF and cerebral autoregulation in children with and without TBI.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

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132

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Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury.

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“…Prior studies have typically excluded children with these conditions for fear of biasing the sample given that outcomes after TBI have been shown to be worse after a single episode of hypotension or hypoxia. 5,8,27 The patient history in children with suspected abusive head trauma may be unreliable, and it may not be possible to accurately determine the time of injury. Despite these issues, and given both the lack of any proven effective treatments for pediatric TBI and the number of children with TBIs who suffer from hypotension, hypoxia, or abusive head trauma, one may argue about the ethics of excluding these children from a future clinical trial of a promising therapeutic agent for TBI.…”

Section: Discussionmentioning

confidence: 99%

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Stanley

Johnson

Vance

et al. 2017

Academic Emergency Medicine

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Objectives: In preparation for a clinical trial of therapeutic agents for children with moderate-to-severe blunt traumatic brain injuries (TBIs) in emergency departments (EDs), we conducted this feasibility study to (1) determine the number and clinical characteristics of eligible children, (2) determine the timing of patient and guardian arrival to the ED, and (3) describe the heterogeneity of TBIs on computed tomography (CT) scans. Methods:We conducted a prospective observational study at 16 EDs of children ≤ 18 years of age presenting with blunt head trauma and Glasgow Coma Scale scores of 3-12. We documented the number of potentially eligible patients, timing of patient and guardian arrival, patient demographics and clinical characteristics, severity of injuries, and cranial CT findings.

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Blood Pressure and Outcome after Severe Pediatric Traumatic Brain Injury

Cited by 112 publications

References 18 publications

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

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