Pediatric Minor Traumatic Brain Injury With Intracranial Hemorrhage

Burns, Erin; Burns, Beech; Newgard, Craig D.; Laurie, Amber; Fu, Rongwei; Graif, Theresa; Ward, Casey S.; Bauer, Abbie; Steinhardt, David; Ibsen, Laura M.; Spiro, David M.

doi:10.1097/pec.0000000000000950

Cited by 14 publications

(24 citation statements)

References 22 publications

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“…16,17 However, this evidence has been based on retrospectively collected single-center data, limiting those results. 16,18 Consequently, there remains an important need to identify which patients with complicated mTBI are safe for ward observation.…”

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confidence: 99%

Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury

et al. 2017

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The appropriate treatment of children with mild traumatic brain injury (mTBI) and intracranial injury (ICI) on computed tomographic imaging remains unclear. Evidence-based risk assessments may improve patient safety and reduce resource use.OBJECTIVE To derive a risk score predicting the need for intensive care unit observation in children with mTBI and ICI. DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis of the prospective Pediatric Emergency Care Applied Research Network (PECARN) head injury cohort study included patients enrolled in 25 North American emergency departments from 2004 to 2006. We included patients younger than 18 years with mTBI (Glasgow Coma Scale [GCS] score, 13-15) and ICI on computed tomography. The data analysis was conducted from May 2015 to October 2016. MAIN OUTCOMES AND MEASURESThe primary outcome was the composite of neurosurgical intervention, intubation for more than 24 hours for TBI, or death from TBI. Multivariate logistic regression was used to predict the outcome. The C statistic was used to quantify discrimination, and model performance was internally validated using 10-fold cross-validation. Based on this modeling, the Children's Intracranial Injury Decision Aid score was created.RESULTS Among 15 162 children with GCS 13 to 15 head injuries who received head computed tomographic imaging in the emergency department, 839 (5.5%) had ICI. The median ages of those with and without a composite outcome were 7 and 5 years, respectively. Among those patients with ICI, 8.7% (n = 73) experienced the primary outcome, including 8.3% (n = 70) who had a neurosurgical intervention. The only clinical variable significantly associated with outcome was GCS score (odds ratio [OR], 3.4; 95% CI, 1.5-7.4 for GCS score 13 vs 15). Significant radiologic predictors included midline shift (OR, 6.8; 95% CI, 3.4-13.8), depressed skull fracture (OR, 6.5; 95% CI, 3.7-11.4), and epidural hematoma (OR, 3.4; 95% CI, 1.8-6.2). The model C statistic was 0.84 (95% CI, 0.79-0.88); the 10-fold cross-validated C statistic was 0.83. Based on this modeling, we developed the Children's Intracranial Injury Decision Aid score, which ranged from 0 to 24 points. The negative predictive value of having 0 points (ie, none of these risk factors) was 98.8% (95% CI, 97.3%-99.6%). CONCLUSIONS AND RELEVANCELower GCS score, midline shift, depressed skull fracture, and epidural hematoma are key risk factors for needing intensive care unit-level care in children with mTBI and ICI. Based on these results, the Children's Intracranial Injury Decision Aid score is a potentially novel tool to risk stratify this population, thereby aiding management decisions.

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confidence: 99%

Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury

et al. 2017

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“…Following this decision rule would lead to a 55% reduction of ICU admissions. 18 This is illustrated in several studies of children with complicated mTBI or with GCS 13 or 14. 24 25 In these studies, the percentage of children admitted to the ICU varied from 28.6 to 36.8%.…”

Section: Epidemiologymentioning

confidence: 98%

“…15 16 Abusive head trauma is suspected in 6.2 to 15% of young children (median age 13 months). 17 18 Mortality from TBI ranges from 0.4 to 3.8%, especially in children with GCS <8, traffic accidents, and severe extracranial injury. 17 19…”

Section: Epidemiologymentioning

confidence: 99%

“…26 However, in children with GCS 13, a severe trauma mechanism is involved in >40%, see Table 2 . 14 18 21 In children (0–18 years old) with moderate TBI, the percentage of a high-energy trauma mechanism is even higher, in >50%. 27…”

Section: Epidemiologymentioning

confidence: 99%

“…Various authors derived a clinical decision rule to determine which children can safely avoid ICU-level care. 18 47 Children with mTBI and intracranial hemorrhage at low risk of critical care intervention had the absence of the following: midline shift, depressed skull fracture, coagulopathy, unwitnessed/unknown trauma mechanism, and relevant (non-extremity) extracranial injuries. Following this decision rule would lead to a 55% reduction of ICU admissions.…”

Section: Epidemiologymentioning

confidence: 99%

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A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review

Hageman

Nihom

2021

Neuropediatrics

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Objective The objective of this article was to compare children with traumatic brain injury (TBI) and Glasgow Coma Scale score (GCS) 13 with children presenting with GCS 14 and 15 and GCS 9 to 12. Data Source We searched PubMed for clinical studies of children of 0 to 18 years of age with mild TBI (mTBI) and moderate TBI, published in English language in the period of 2000 to 2020. Study Selection We selected studies sub-classifying children with GCS 13 in comparison with GCS 14 and 15 and 9 to 12. We excluded reviews, meta-analyses, non-U.S./European population studies, studies of abusive head trauma, and severe TBI. Data Synthesis Most children (>85%) with an mTBI present at the emergency department with an initial GCS 15. A minority of only 5% present with GCS 13, 40% of which sustain a high-energy trauma. Compared with GCS 15, they present with a longer duration of unconsciousness and of post-traumatic amnesia. More often head computerized tomography scans show abnormalities (in 9–16%), leading to neurosurgical intervention in 3 to 8%. Also, higher rates of severe extracranial injury are reported. Admission is indicated in more than 90%, with a median length of hospitalization of more than 4 days and 28% requiring intensive care unit level care. These data are more consistent with children with GCS 9 to 12. In children with GCS 15, all these numbers are much lower. Conclusion We advocate classifying children with GCS 13 as moderate TBI and treat them accordingly.

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Neuroinflammation and neurodegeneration following traumatic brain injuries

Boulton,

Al-Rubaie

2024

Anat Sci Int

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Traumatic brain injuries (TBI) commonly occur following head trauma. TBI may result in short- and long-term complications which may lead to neurodegenerative consequences, including cognitive impairment post-TBI. When investigating the neurodegeneration following TBI, studies have highlighted the role reactive astrocytes have in the neuroinflammation and degeneration process. This review showcases a variety of markers that show reactive astrocyte presence under pathological conditions, including glial fibrillary acidic protein (GFAP), Crystallin Alpha-B (CRYA-B), Complement Component 3 (C3) and S100A10. Astrocyte activation may lead to white-matter inflammation, expressed as white-matter hyperintensities. Other white-matter changes in the brain following TBI include increased cortical thickness in the white matter. This review addresses the gaps in the literature regarding post-mortem human studies focussing on reactive astrocytes, alongside the potential uses of these proteins as markers in the future studies that investigate the proportions of astrocytes in the post-TBI brain has been discussed. This research may benefit future studies that focus on the role reactive astrocytes play in the post-TBI brain and may assist clinicians in managing patients who have suffered TBI.

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Pediatric Minor Traumatic Brain Injury With Intracranial Hemorrhage

Abstract: A subset of low-risk patients may not require ICU admission. The proposed decision rule identified low-risk children with tICH who may be observable outside an ICU, although this rule requires external validation before implementation.

Cited by 14 publications

References 22 publications

Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury

Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury

A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review

Neuroinflammation and neurodegeneration following traumatic brain injuries

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