Risk of Infection and Sepsis in Pediatric Patients with Traumatic Brain Injury Admitted to Hospital Following Major Trauma

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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Effects of hypertonic saline on intracranial pressure and cerebral autoregulation in pediatric traumatic brain injury

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.6.peds21143 ◽

2021 ◽

pp. 1-7

Author(s):

Julian Zipfel ◽

Juliane Engel ◽

Konstantin Hockel ◽

Ellen Heimberg ◽

Martin U. Schuhmann ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Hypertonic Saline ◽

Pediatric Patients ◽

Injury Severity ◽

Primary Outcome Measure ◽

Favorable Outcome ◽

Outcome Group ◽

Significant Difference

OBJECTIVE Hypertonic saline (HTS) is commonly used in children to lower intracranial pressure (ICP) after severe traumatic brain injury (sTBI). While ICP and cerebral perfusion pressure (CPP) correlate moderately to TBI outcome, indices of cerebrovascular autoregulation enhance the correlation of neuromonitoring data to neurological outcome. In this study, the authors sought to investigate the effect of HTS administration on ICP, CPP, and autoregulation in pediatric patients with sTBI. METHODS Twenty-eight pediatric patients with sTBI who were intubated and sedated were included. Blood pressure and ICP were actively managed according to the autoregulation index PRx (pressure relativity index to determine and maintain an optimal CPP [CPPopt]). In cases in which ICP was continuously > 20 mm Hg despite all other measures to decrease it, an infusion of 3% HTS was administered. The monitoring data of the first 6 hours after HTS administration were analyzed. The Glasgow Outcome Scale (GOS) score at the 3-month follow-up was used as the primary outcome measure, and patients were dichotomized into favorable (GOS score 4 or 5) and unfavorable (GOS score 1–3) groups. RESULTS The mean dose of HTS was 40 ml 3% NaCl. No significant difference in ICP and PRx was seen between groups at the HTS administration. ICP was lowered significantly in all children, with the effect lasting as long as 6 hours. The lowering of ICP was significantly greater and longer in children with a favorable outcome (p < 0.001); only this group showed significant improvement of autoregulatory capacity (p = 0.048). A newly established HTS response index clearly separated the outcome groups. CONCLUSIONS HTS significantly lowered ICP in all children after sTBI. This effect was significantly greater and longer-lasting in children with a favorable outcome. Moreover, HTS administration restored disturbed autoregulation only in the favorable outcome group. This highlights the role of a “rescuable” autoregulation regarding outcome, which might be a possible indicator of injury severity. The effect of HTS on autoregulation and other possible mechanisms should be further investigated.

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Efficacy of a novel eye tracking system to evaluate mild traumatic brain injury in pediatric patients

Journal of Neurology & Neurophysiology ◽

10.4172/2155-9562-c3-104 ◽

2019 ◽

Vol 10 ◽

Author(s):

Brian Still

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Eye Tracking ◽

Mild Traumatic Brain Injury ◽

Pediatric Patients ◽

Tracking System

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Comparing the outcomes of isolated, serious traumatic brain injury in older adults managed at major trauma centres and neurosurgical services: A registry-based cohort study

Injury ◽

10.1016/j.injury.2019.06.012 ◽

2019 ◽

Vol 50 (9) ◽

pp. 1534-1539 ◽

Cited By ~ 2

Author(s):

Matthew S. Dunn ◽

Ben Beck ◽

Pam M. Simpson ◽

Peter A. Cameron ◽

Marcus Kennedy ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Cohort Study ◽

Brain Injury ◽

Major Trauma ◽

Trauma Centres

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Oculomotor Behavior as a Biomarker for Differentiating Pediatric Patients With Mild Traumatic Brain Injury and Age Matched Controls

Frontiers in Behavioral Neuroscience ◽

10.3389/fnbeh.2020.581819 ◽

2020 ◽

Vol 14 ◽

Author(s):

Melissa Hunfalvay ◽

Nicholas P. Murray ◽

Claire-Marie Roberts ◽

Ankur Tyagi ◽

Kyle William Barclay ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Pediatric Patients ◽

Oculomotor Behavior

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CDC's guideline on pediatric mild traumatic brain injury

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000624 ◽

2019 ◽

Vol 9 (3) ◽

pp. 241-249 ◽

Cited By ~ 2

Author(s):

Barbara Weissman ◽

Madeline Joseph ◽

Gary Gronseth ◽

Kelly Sarmiento ◽

Christopher C. Giza

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Pediatric Patients ◽

Young Patients ◽

Evidence Based ◽

Practice Recommendations ◽

Control And Prevention ◽

Evidence Based Guideline ◽

American Academy Of Neurology

Purpose of reviewIn September 2018, the Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children.Recent findingsBased on a systematic review of the evidence that covers research published over a 25-year span (1990–2015), the CDC Pediatric mTBI Guideline strives to optimize the care of pediatric patients with mTBI. The guideline was developed using a rigorous methodology developed by the American Academy of Neurology.SummaryClinical practice recommendations in the CDC Pediatric mTBI Guideline can help guide neurologists with critical diagnostic and management decisions and to implement evidence-based strategies for the recovery of their young patients with this injury.

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Quantitation of Metabolic Change in Serial FDG-PET Brain Scans of Pediatric Patients with Traumatic Brain Injury

IFMBE Proceedings - 25th Southern Biomedical Engineering Conference 2009, 15 – 17 May 2009, Miami, Florida, USA ◽

10.1007/978-3-642-01697-4_22 ◽

2009 ◽

pp. 61-62

Author(s):

M. F. Georgiou ◽

R. A. Kuker ◽

J. Kuluz ◽

G. N. Sfakianakis

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Fdg Pet ◽

Pediatric Patients ◽

Metabolic Change ◽

Brain Scans

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Advanced Neuromonitoring and Imaging in Pediatric Traumatic Brain Injury

Critical Care Research and Practice ◽

10.1155/2012/361310 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Stuart H. Friess ◽

Todd J. Kilbaugh ◽

Jimmy W. Huh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Early Detection ◽

Pediatric Patients ◽

Vital Signs ◽

Pediatric Traumatic Brain Injury ◽

Pressure Monitoring ◽

Biomarker Analysis ◽

Insight Into

While the cornerstone of monitoring following severe pediatric traumatic brain injury is serial neurologic examinations, vital signs, and intracranial pressure monitoring, additional techniques may provide useful insight into early detection of evolving brain injury. This paper provides an overview of recent advances in neuromonitoring, neuroimaging, and biomarker analysis of pediatric patients following traumatic brain injury.

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