Epidemiology and Outcomes of Pediatric Traumatic Brain Injury

Keenan, Heather T.; Bratton, Susan L.

doi:10.1159/000094152

Cited by 231 publications

(161 citation statements)

References 101 publications

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“…45,52 Recent evidence has shown that older teens generally demonstrate better outcomes than younger children, perhaps due to greater vulnerability among younger children to more severe physical injury. 3,4,28,32 Despite these factors, however, children overall tend to have better clinical outcomes following TBI than adults. 3,4,28 To investigate the reasons for such differences in outcomes, many animal models have been used to compare young versus old age and TBI.…”

Section: Differences In Tbi Within the Pediatric Populationmentioning

confidence: 99%

“…3,4,28,32 Despite these factors, however, children overall tend to have better clinical outcomes following TBI than adults. 3,4,28 To investigate the reasons for such differences in outcomes, many animal models have been used to compare young versus old age and TBI. Studies have examined the role of biomechanics, 35 metabolism, 43 cell death, 9,25 electrophysiology, 17,44 and glutamatergic neurotransmission 23,24 as possible mechanisms to explain the improved clinical outcome in pediatric compared with adult patients.…”

Section: Differences In Tbi Within the Pediatric Populationmentioning

confidence: 99%

“…In both children and adults, a bilateral frontotemporoparietal craniectomy is often used for diffuse bilateral swelling, while a unilateral frontotemporoparietal craniectomy is chosen for unilateral brain swelling. 21,25,30 A variety of specialized techniques have also been reported in children, including smaller, 4-cm bitemporal craniectomies, 48 larger craniectomies, 25,28 and craniectomy combined with expansion duraplasty. 14,18,42 To date no study has compared the efficacy of the various techniques in improving outcome.…”

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

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Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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Section: Differences In Tbi Within the Pediatric Populationmentioning

confidence: 99%

Section: Differences In Tbi Within the Pediatric Populationmentioning

confidence: 99%

Section: Surgical Interventions For Tbi In the Pediatric Populationmentioning

confidence: 99%

See 1 more Smart Citation

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Appelboom

Zoller

Piazza

et al. 2011

FOC

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“…Intracranial injury is a leading cause of mortality and morbidity in children. 6 A skull fracture may be an indicator of intracranial injury; hence, an accurate diagnosis in pediatric head trauma is important.…”

mentioning

confidence: 99%

Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging?

Orman¹,

Wagner²,

Seeburg³

et al. 2015

PED

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OBJECT The authors compared the efficacy of combining 2D+3D CT reconstructions with standard 2D CT images in the diagnosis of linear skull fractures in children with head trauma. METHODS This was a retrospective evaluation of consecutive head CT studies of children presenting with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Three readers independently evaluated the 2D CT images alone and then in combination with the 3D reconstructions for the diagnosis of linear skull fractures. Sensitivity and specificity in the diagnosis of linear skull fractures utilizing 2D and 2D+3D CT in combination were measured for children less than 2 years of age and for all children for analysis by the 3 readers. RESULTS Included in the study were 250 consecutive CT studies of 250 patients (167 boys and 83 girls). The mean age of the children was 7.82 years (range 4 days to 17.4 years). 2D+3D CT combined had a higher sensitivity and specificity (83.9% and 97.1%, respectively) compared with 2D alone (78.2% and 92.8%, respectively) with statistical significance for specificity (p < 0.05) in children less than 2 years of age. 2D+3D CT combined had a higher sensitivity and specificity (81.3% and 90.5%, respectively) compared with 2D alone (74.5% and 89.1%, respectively) with statistical significance for sensitivity (p < 0.05) in all children. CONCLUSIONS In this study, 2D+3D CT in combination showed increased sensitivity in the diagnosis of linear skull fractures in all children and increased specificity in children less than 2 years of age. In children less than 2 years of age, added confidence in the interpretation of fractures by distinguishing them from sutures may have a significant implication in the setting of nonaccidental trauma. Furthermore, 3D CT is available at no added cost, scan time, or radiation exposure, providing trainees and clinicians with limited experience an additional valuable tool for routine imaging of pediatric head trauma.

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“…Unique to pediatrics is inflicted traumatic brain injury (iTBI), a major cause of TBI in young patients [17]. Inflicted injury is associated with worse outcome compared to accidental trauma and represents a disproportionate number of deaths in the patients 2 years of age [18][19][20][21]. Different biomechanical mechanisms of injury, exposure to multiple repeated insults, younger age of patients, and secondary injury factors, such as hypoxia and seizures, have all been proposed as potential factors.…”

Section: How Is Tbi Different In Children?mentioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

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Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

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Epidemiology and Outcomes of Pediatric Traumatic Brain Injury

Cited by 231 publications

References 101 publications

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging?

Pediatric Neurocritical Care

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