Pediatric Traumatic Brain Injury: Common Data Elements to Inform Diagnosis, Neuroimaging, and Outcome Metrics

OBJECTIVEThe goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.METHODSData collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.RESULTSThe sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85–0.96]), headache frequency (HR 0.83 [95% CI 0.71–0.96]), confusion (HR 0.79 [95% CI 0.69–0.92]), forgetfulness (HR 0.79 [95% CI 0.68–0.92]), attention difficulties (HR 0.83 [95% CI 0.72–0.96]), trouble remembering (HR 0.84 [95% CI 0.72–0.98]), getting tired often (HR 0.86 [95% CI 0.76–0.97]), getting tired easily (HR 0.86 [95% CI 0.76–0.98]), dizziness (HR 0.86 [95% CI 0.75–0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40–0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44–0.98]; p = 0.038).CONCLUSIONSFor children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.

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Utility of a pediatric fast magnetic resonance imaging protocol as surveillance scanning for traumatic brain injury

Shope

Alshareef²,

Larrew³

et al. 2021

Journal of Neurosurgery: Pediatrics

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OBJECTIVETraumatic brain injury (TBI) is a prevalent pediatric pathology in the modern emergency department. Computed tomography (CT) is utilized for detection of TBI and can result in cumulatively high radiation exposure. Recently, a fast brain magnetic resonance imaging (fbMRI) protocol has been employed for rapid imaging of hydrocephalus in pediatric patients. The authors investigate the utility of a modified trauma-focused fbMRI (t-fbMRI) protocol as an alternative to surveillance CT in the setting of acute TBI in pediatric patients, thus reducing radiation exposure while improving diagnostic yield.METHODSA retrospective review was performed at the authors’ institution for all pediatric patients who had undergone t-fbMRI within 72 hours of an initial CT scan, using a 1.5- or 3-T MR scanner for trauma indications. Forty patients met the study inclusion criteria. The authors performed a comparison of findings on the reads of CT and fbMRI, and a board-certified neuroradiologist conducted an independent review of both modalities.RESULTST-fbMRI outperformed CT in specificity, sensitivity, and negative predictive value for all injury pathologies measured, except for skull fractures. T-fbMRI demonstrated a sensitivity of 100% in the detection of extraaxial bleed, intraventricular hemorrhage, and subarachnoid hemorrhage and had a sensitivity of 78% or greater for epidural hematoma, subdural hematoma, and intraparenchymal hemorrhage. T-fbMRI yielded a specificity of 100% for all types of intracranial hemorrhages, with a corresponding negative predictive value that exceeded that for CT.CONCLUSIONSIn pediatric populations, the t-fbMRI protocol provides a valid alternative to CT in the surveillance of TBI and intracranial hemorrhage. Although not as sensitive in the detection of isolated skull fractures, t-fbMRI can be used to monitor pathologies implicated in TBI patients while minimizing radiation exposure from traditional surveillance imaging.

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Pediatric Traumatic Brain Injury: Common Data Elements to Inform Diagnosis, Neuroimaging, and Outcome Metrics

Cited by 3 publications

References 52 publications

Functional magnetic resonance imaging study of working memory several years after pediatric concussion

Functional magnetic resonance imaging study of working memory several years after pediatric concussion

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

Utility of a pediatric fast magnetic resonance imaging protocol as surveillance scanning for traumatic brain injury

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