Validation of prognostic models in intensive care unit–treated pediatric traumatic brain injury patients

2019 ◽  
Vol 24 (3) ◽  
pp. 330-337 ◽  
Author(s):  
Era D. Mikkonen ◽  
Markus B. Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Classification Systems ◽  
Prognostic Models ◽  
Pediatric Traumatic Brain Injury ◽  
Pediatric Tbi ◽  
The Impact

OBJECTIVEThere are few specific prognostic models specifically developed for the pediatric traumatic brain injury (TBI) population. In the present study, the authors tested the predictive performance of existing prognostic tools, originally developed for the adult TBI population, in pediatric TBI patients requiring stays in the ICU.METHODSThe authors used the Finnish Intensive Care Consortium database to identify pediatric patients (< 18 years of age) treated in 4 academic ICUs in Finland between 2003 and 2013. They tested the predictive performance of 4 classification systems—the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) TBI model, the Helsinki CT score, the Rotterdam CT score, and the Marshall CT classification—by assessing the area under the receiver operating characteristic curve (AUC) and the explanatory variation (pseudo-R2 statistic). The primary outcome was 6-month functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5).RESULTSOverall, 341 patients (median age 14 years) were included; of these, 291 patients had primary head CT scans available. The IMPACT core-based model showed an AUC of 0.85 (95% CI 0.78–0.91) and a pseudo-R2 value of 0.40. Of the CT scoring systems, the Helsinki CT score displayed the highest performance (AUC 0.84, 95% CI 0.78–0.90; pseudo-R2 0.39) followed by the Rotterdam CT score (AUC 0.80, 95% CI 0.73–0.86; pseudo-R2 0.34).CONCLUSIONSPrognostic tools originally developed for the adult TBI population seemed to perform well in pediatric TBI. Of the tested CT scoring systems, the Helsinki CT score yielded the highest predictive value.

scholarly journals Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury

2021 ◽  
Author(s):  
Ankur Dhanda ◽  
Ashish Bindra ◽  
Roshni Dhakal ◽  
Siddharth Chavali ◽  
Gyaninder Pal Singh ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Head Injury ◽  
Median Duration ◽  
Independent Predictor ◽  
Patient Characteristics ◽  
Pediatric Traumatic Brain Injury ◽  
Poor Outcome ◽  
Pediatric Tbi

Abstract Background Pediatric traumatic brain injury (TBI) has distinctive pathophysiology and characteristics that differ from adults. These can be attributed to age-related anatomical and physiological differences and distinct patterns of injuries seen in children. Our aim was to identify the patient characteristics, clinical variables during intensive care and intraoperative management associated with poor functional outcome in a cohort of pediatric TBI patients. Methods Retrospective chart review of pediatric TBI patients admitted to neurotrauma intensive care unit (NICU) over a period of 1 year. Results A total of 105 children (< 12 years) with head injury were admitted in the NICU during the study period. The most common mechanism of injury was fall in 78% cases. Fifty-four patients (51.4%) presented with a severe head injury (Glasgow coma scale [GCS] ≤ 8), while 31 (29.5%) and 20 (19.1%) had a mild and moderate head injury. The most common finding was skull fractures (59%), contusions (36.2%), and subdural hematoma (SDH) (30.4%). Forty nine patients (46.7%) required surgical management. The median duration of anesthesia was 205 (interquartile range [IQR] 65, 375) minutes, and median blood loss during the surgery was 16.7 mL/kg body weight with 41% requiring intraoperative blood transfusions. Median duration of ICU and hospital stay was 5 (IQR 1, 47) and 8 (IQR 1, 123) days, respectively. GOS at discharge ≤ 3 representing poor outcome was present in 35 patients (33.3%). Mortality was seen in 15 (14.3%) patients. Multivariate analysis identified postresuscitation GCS ≤ 8 on admission as independent predictor of mortality, and postresuscitation GCS ≤ 8 on admission and NICU stay of > 7 days as independent predictor of poor outcome. Conclusion Despite advances in neurointensive care, mortality and morbidity remains high in pediatric head trauma and is mainly dependent on postresuscitation GCS and NICU stay of more than 7 days. Multidimensional approach is required for its prevention and management.

One-year costs of intensive care in pediatric patients with traumatic brain injury

2021 ◽  
Vol 27 (1) ◽  
pp. 79-86
Author(s):  
Era D. Mikkonen ◽  
Markus B. Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Social Security ◽  
Functional Outcome ◽  
Injury Severity ◽  
Pediatric Population ◽  
Favorable Outcome ◽  
Index Hospitalization ◽  
Pediatric Tbi

OBJECTIVETraumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients.METHODSIn this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0–17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO).RESULTSIn total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3–12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326–€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335–€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas.CONCLUSIONSGreater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.

scholarly journals Longitudinal Growth Curve Trajectories of Family Dynamics after Pediatric Traumatic Brain Injury in Mexico

2020 ◽  
Vol 17 (22) ◽  
pp. 8508
Author(s):  
Grace B. McKee ◽  
Laiene Olabarrieta-Landa ◽  
Paula K. Pérez-Delgadillo ◽  
Ricardo Valdivia-Tangarife ◽  
Teresita Villaseñor-Cabrera ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Family Functioning ◽  
Growth Curve ◽  
Family Members ◽  
Family Satisfaction ◽  
Health Concern ◽  
Pediatric Traumatic Brain Injury ◽  
Large Hospital ◽  
Pediatric Tbi

Pediatric traumatic brain injury (TBI) represents a serious public health concern. Family members are often caregivers for children with TBI, which can result in a significant strain on familial relationships. Research is needed to examine aspects of family functioning in the context of recovery post-TBI, especially in Latin America, where cultural norms may reinforce caregiving by family members, but where resources for these caregivers may be scarce. This study examined caregiver-reported family satisfaction, communication, cohesion, and flexibility at three time points in the year post-injury for 46 families of a child with TBI in comparison to healthy control families. Families experiencing pediatric TBI were recruited from a large hospital in Guadalajara, Mexico, while healthy controls were recruited from a local educational center. Results from multilevel growth curve models demonstrated that caregivers of children with a TBI reported significantly worse family functioning than controls at each assessment. Families experiencing pediatric TBI were unable to attain the level of functioning of controls during the time span studied, suggesting that these families are likely to experience long-term disruptions in family functioning. The current study highlights the need for family-level intervention programs to target functioning for families affected by pediatric TBI who are at risk for difficulties within a rehabilitation context.

scholarly journals Posttraumatic epilepsy in intensive care unit–treated pediatric traumatic brain injury patients

Epilepsia ◽  
2020 ◽  
Vol 61 (4) ◽  
pp. 693-701
Author(s):  
Era D. Mikkonen ◽  
Markus B. Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Pediatric Traumatic Brain Injury ◽  
Posttraumatic Epilepsy

scholarly journals Changes in the gray and white matter of patients with ischemic-edematous insults after traumatic brain injury

2019 ◽  
Vol 131 (4) ◽  
pp. 1243-1253 ◽  
Author(s):  
Hakseung Kim ◽  
Young-Tak Kim ◽  
Eun-Suk Song ◽  
Byung C. Yoon ◽  
Young Hun Choi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Area Under The Curve ◽  
Hounsfield Unit ◽  
Predictive Performance ◽  
Prognostic Models ◽  
Quantitative Ct ◽  
Densitometric Analysis ◽  
Secondary Insult

OBJECTIVEGray matter (GM) and white matter (WM) are vulnerable to ischemic-edematous insults after traumatic brain injury (TBI). The extent of secondary insult after brain injury is quantifiable using quantitative CT analysis. One conventional quantitative CT measure, the gray-white matter ratio (GWR), and a more recently proposed densitometric analysis are used to assess the extent of these insults. However, the prognostic capacity of the GWR in patients with TBI has not yet been validated. This study aims to test the prognostic value of the GWR and evaluate the alternative parameters derived from the densitometric analysis acquired during the acute phase of TBI. In addition, the prognostic ability of the conventional TBI prognostic models (i.e., IMPACT [International Mission for Prognosis and Analysis of Clinical Trials in TBI] and CRASH [Corticosteroid Randomisation After Significant Head Injury] models) were compared to that of the quantitative CT measures.METHODSThree hundred patients with TBI of varying ages (92 pediatric, 94 adult, and 114 geriatric patients) and admitted between 2008 and 2013 were included in this retrospective cohort study. The normality of the density of the deep GM and whole WM was evaluated as the proportion of CT pixels with Hounsfield unit values of 31–35 for GM and 26–30 for WM on CT images of the entire supratentorial brain. The outcome was evaluated using the Glasgow Outcome Scale (GOS) at discharge (GOS score ≤ 3, n = 100).RESULTSLower proportions of normal densities in the deep GM and whole WM indicated worse outcomes. The proportion of normal WM exhibited a significant prognostic capacity (area under the curve [AUC] = 0.844). The association between the outcome and the normality of the WM density was significant in adult (AUC = 0.792), pediatric (AUC = 0.814), and geriatric (AUC = 0.885) patients. In pediatric patients, the normality of the overall density and the density of the GM were indicative of the outcome (AUC = 0.751). The average GWR was not associated with the outcome (AUC = 0.511). IMPACT and CRASH models showed adequate and reliable performance in the pediatric and geriatric groups but not in the adult group. The highest overall predictive performance was achieved by the densitometry-augmented IMPACT model (AUC = 0.881).CONCLUSIONSBoth deep GM and WM are susceptible to ischemic-edematous insults during the early phase of TBI. The extent of the secondary injury was better evaluated by analyzing the normality of the deep GM and WM rather than by calculating the GWR.

scholarly journals Epidemiology of Pediatric Traumatic Brain Injury in Brazil

2021 ◽  
Author(s):  
Leandro Cândido de Souza ◽  
Ricardo Santos de Oliveira ◽  
Francisco de Assis Carvalho do Vale ◽  
Matheus Fernando Manzolli Ballestero
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Admissions ◽  
Pediatric Population ◽  
Case Fatality ◽  
Public Health Problem ◽  
Emerging Countries ◽  
Pediatric Traumatic Brain Injury ◽  
Important Public Health Problem ◽  
Pediatric Tbi

Background: Pediatric traumatic brain injury (TBI) is a serious social and economic problem. Emerging countries have 89% of the cases worldwide and lack relevant epidemiological studies on the subject. Objectives: Characterize the demographic, social and economic profiles of the pediatric population suffering TBI in Brazil. Methods: Data on the cases of pediatric TBI in Brazil between 2008 and 2020 were collected through the computer department of the Unified Health System (DATASUS) maintained by the Brazilian Ministry of Health. Results: There are about 28,836 hospital admissions due to pediatric TBI per year and an incidence of 45.11 admissions /100,000/year. The in-hospital mortality rate was 1.47/100,000/year, and the case fatality rate was 3.26%. The average annual cost of hospital expenses was US$ 12.311.759, with the average admission cost having a value of US $417. The 15–19 age group was the most frequently admitted to hospital for pediatric TBI and had the highest number of in- hospital deaths; in addition, more males were affected by this trauma compared to females at a rate of 2.31:1. Ethnic populations that are social minorities are more susceptible to a poor prognosis of TBI. Conclusion: Pediatric TBI should be recognized as an important public health problem in Brazil, as it is responsible for considerable social and economic costs. Public policies that reduce the causes of this type of trauma in the pediatric population are urgently needed in Brazil and other emerging countries.

scholarly journals Clinical guidelines for traumatic brain injuries in children and boys

2020 ◽  
Vol 30 (1) ◽  
pp. 159-170
Author(s):  
Hojjat Derakhshanfar ◽  
Elham Pourbakhtyaran ◽  
Samane Rahimi ◽  
Samira Sayyah ◽  
Zahra Soltantooyeh ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Clinical Practice ◽  
Brain Injury ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Guidelines ◽  
Pediatric Traumatic Brain Injury ◽  
Normal Ranges ◽  
Pediatric Tbi

The main aim of management of pediatric traumatic brain injury (TBI)  is to hold normal ranges for optimizing the most proper outcomes. However, for providing physiologic requirements of an injured brain it is very important to enhance the quality of recovery and minimize secondary injury. Within this study it is tried to regulate the most proper guidelines for management of pediatric TBI. A comprehensive research was conducted on some biomedical and pharmacological bibliographic database of life sciences such as PubMed, EMBASE, MEDLINE, LILACS database, global independent network of Cochrane, Science Direct and global health library of Global Index Medicus (GIM). By referencing these databases, a universal literature review was carried out through combining various recent studies in terms of pediatric traumatic brain injury, epidemiology, management and related clinical guidelines in accordance with various related articles published from 2000 to 2019 which could cover this area of recommendations.Based on the main objective of this study for providing a comprehensive review around available clinical practice guidelines for more precise management of TBI. These guidelines can be administered especially for pediatric population which possibly could improve the quality of clinical practice guidelines for TBI. The guidelines of TBI could be applied worldwide in various traditional demographic and geographic boundaries which could affect pediatric populations in various ranges of ages. Accordingly, advances in civil foundation and reforms of explicit health policy could decrease the pediatric TBI socioeconomic burdens.

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