Rapid-sequence MRI for evaluation of pediatric traumatic brain injury: a systematic review

2021 ◽  
pp. 1-9
Author(s):  
Brice A. Kessler ◽  
Jo Ling Goh ◽  
Hengameh B. Pajer ◽  
Anthony M. Asher ◽  
Weston T. Northam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Mri ◽  
Skull Fractures ◽  
Pediatric Traumatic Brain Injury ◽  
Rapid Sequence ◽  
Mri Protocol ◽  
Ionizing Radiation Exposure ◽  
Pediatric Tbi

OBJECTIVE Rapid-sequence MRI (RSMRI) of the brain is a limited-sequence MRI protocol that eliminates ionizing radiation exposure and reduces imaging time. This systematic review sought to examine studies of clinical RSMRI use for pediatric traumatic brain injury (TBI) and to evaluate various RSMRI protocols used, including their reported accuracy as well as clinical and systems-based limitations to implementation. METHODS PubMed, EMBASE, and Web of Science databases were searched, and clinical articles reporting the use of a limited brain MRI protocol in the setting of pediatric head trauma were identified. RESULTS Of the 1639 articles initially identified and reviewed, 13 studies were included. An additional article that was in press at the time was provided by its authors. The average RSMRI study completion time was variable, spanning from 1 minute to 16 minutes. RSMRI with “blood-sensitive” sequences was more sensitive for detection of hemorrhage compared with head CT (HCT), but less sensitive for detection of skull fractures. Compared with standard MRI, RSMRI had decreased sensitivity for all evidence of trauma. CONCLUSIONS Protocols and uses of RSMRI for pediatric TBI were variable among the included studies. While traumatic pathology missed by RSMRI, such as small hemorrhages and linear, nondisplaced skull fractures, was frequently described as clinically insignificant, in some cases these findings may be prognostically and/or forensically significant. Institutions should integrate RSMRI into pediatric TBI management judiciously, relying on clinical context and institutional capabilities.

scholarly journals QuickBrain MRI for the detection of acute pediatric traumatic brain injury

2017 ◽  
Vol 19 (2) ◽  
pp. 259-264 ◽  
Author(s):  
David C. Sheridan ◽  
Craig D. Newgard ◽  
Nathan R. Selden ◽  
Mubeen A. Jafri ◽  
Matthew L. Hansen
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sensitivity And Specificity ◽  
Imaging Modality ◽  
Brain Mri ◽  
Ct Imaging ◽  
Pediatric Traumatic Brain Injury ◽  
Mri Protocol ◽  
Level I ◽  
Mass Lesions

OBJECTIVE The current gold-standard imaging modality for pediatric traumatic brain injury (TBI) is CT, but it confers risks associated with ionizing radiation. QuickBrain MRI (qbMRI) is a rapid brain MRI protocol that has been studied in the setting of hydrocephalus, but its ability to detect traumatic injuries is unknown. METHODS The authors performed a retrospective cohort study of pediatric patients with TBI who were undergoing evaluation at a single Level I trauma center between February 2010 and December 2013. Patients who underwent CT imaging of the head and qbMRI during their acute hospitalization were included. Images were reviewed independently by 2 neuroradiology fellows blinded to patient identifiers. Image review consisted of identifying traumatic mass lesions and their intracranial compartment and the presence or absence of midline shift. CT imaging was used as the reference against which qbMRI was measured. RESULTS A total of 54 patients met the inclusion criteria; the median patient age was 3.24 years, 65% were male, and 74% were noted to have a Glasgow Coma Scale score of 14 or greater. The sensitivity and specificity of qbMRI to detect any lesion were 85% (95% CI 73%–93%) and 100% (95% CI 61%–100%), respectively; the sensitivity increased to 100% (95% CI 89%–100%) for clinically important TBIs as previously defined. The mean interval between CT and qbMRI was 27.5 hours, and approximately half of the images were obtained within 12 hours. CONCLUSIONS In this retrospective pilot study, qbMRI demonstrated reasonable sensitivity and specificity for detecting a lesion or injury seen with neuroimaging (radiographic TBI) and clinically important acute pediatric TBI.

scholarly journals Virtual Reality for Pediatric Traumatic Brain Injury Rehabilitation: A Systematic Review

2018 ◽  
Vol 14 (1) ◽  
pp. 6-15 ◽  
Author(s):  
Jiabin Shen ◽  
Sarah Johnson ◽  
Cheng Chen ◽  
Henry Xiang
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Virtual Reality ◽  
Brain Injury ◽  
Research Quality ◽  
Future Research ◽  
Pediatric Traumatic Brain Injury ◽  
Injury Rehabilitation ◽  
Positive Effects ◽  
Pediatric Tbi

Objective. Pediatric traumatic brain injury (TBI) is associated with physical and psychobehavioral impairment in children. Effective rehabilitation programs postinjury are critical for children with TBI. Virtual reality (VR) has been increasingly adopted for brain injury rehabilitation. However, scientific synthesis is lacking in evaluating its effectiveness in pediatric TBI rehabilitation. This article aimed to conduct a systematic review on the effectiveness of VR-based pediatric TBI rehabilitation. Methods. A systematic literature search was conducted in PubMed, PsycInfo, SCOPUS, CENTRAL, BioMed Central, CiNAHL, and Web of Science through November 2015. Personal libraries and relevant references supplemented the search. Two authors independently reviewed the abstracts and/or full text of 5824 articles. Data extraction and qualitative synthesis was conducted along with quantitative assessment of research quality by 2 authors. Results. A positive impact was found for VR-based interventions on children’s physical rehabilitation post-TBI. The quality of research evidence was moderate, which largely suffered from small samples, lack of immersive VR experience, and lack of focus on socioemotional outcomes post-TBI. Conclusions. The present review identified positive effects of VR interventions for pediatric TBI rehabilitation especially in physical outcomes. Future research should include larger samples and broader post-TBI outcomes in children using VR-based interventions.

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.

Pediatric traumatic brain injury and antisocial behavior: are they linked? A systematic review

Brain Injury ◽  
2019 ◽  
Vol 33 (10) ◽  
pp. 1272-1292
Author(s):  
Giulia Bellesi ◽  
Edward D. Barker ◽  
Laura Brown ◽  
Lucia Valmaggia
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Antisocial Behavior ◽  
Pediatric Traumatic Brain Injury

scholarly journals Systematic Review of Clinical Research on Biomarkers for Pediatric Traumatic Brain Injury

2013 ◽  
Vol 30 (5) ◽  
pp. 324-338 ◽  
Author(s):  
Linda Papa ◽  
Michelle M. Ramia ◽  
Jared M. Kelly ◽  
Stephen S. Burks ◽  
Artur Pawlowicz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Research ◽  
Pediatric Traumatic Brain Injury

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 Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery

SLEEP ◽  
2020 ◽  
Vol 43 (10) ◽  
Author(s):  
Madison Luther ◽  
Katrina M Poppert Cordts ◽  
Cydni N Williams
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sleep Disturbances ◽  
Small Sample Size ◽  
Evaluation Studies ◽  
Small Sample ◽  
Risk Of Bias ◽  
Pediatric Tbi

Abstract Study Objectives Sleep is vital for brain development and healing after injury, placing children with sleep-wake disturbances (SWD) after traumatic brain injury (TBI) at risk for worse outcomes. We conducted a systematic review to quantify SWD after pediatric TBI including prevalence, phenotypes, and risk factors. We also evaluated interventions for SWD and the association between SWD and other posttraumatic outcomes. Methods Systematic searches were conducted in MEDLINE, PsychINFO, and reference lists for English language articles published from 1999 to 2019 evaluating sleep or fatigue in children hospitalized for mild complicated, moderate, or severe TBI. Two independent reviewers assessed eligibility, extracted data, and assessed risk of bias using the Newcastle–Ottowa Score for observational studies. Results Among 966 articles identified in the search, 126 full-text articles were reviewed, and 24 studies were included (11 prospective, 9 cross-sectional, and 4 case studies). Marked heterogeneity was found in study populations, measures defining SWD, and time from injury to evaluation. Studies showed at least 20% of children with TBI had trouble falling or staying asleep, fatigue, daytime sleepiness, and nightmares. SWD are negatively correlated with posttraumatic cognitive, behavioral, and quality of life outcomes. No comparative intervention studies were identified. The risk of bias was moderate–high for all studies often related to lack of validated or objective SWD measures and small sample size. Heterogeneity precluded meta-analyses. Conclusions SWD are important morbidities after pediatric TBI, though current data are limited. SWD have implications for TBI recovery and may represent a modifiable target for improving outcomes after pediatric TBI.

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.

Pediatric Mild Traumatic Brain Injury: Who Can Be Managed at a Non-pediatric Trauma Center Hospital? A Systematic Review of the Literature

2021 ◽  
pp. 000313482110508
Author(s):  
Olivia A. Keane ◽  
Mauricio A. Escobar ◽  
Lucas P. Neff ◽  
Ian C. Mitchell ◽  
Joshua J. Chern ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Pediatric Trauma ◽  
Evidence Based ◽  
Review Of The Literature ◽  
Mild Tbi ◽  
Pediatric Tbi ◽  
Pediatric Trauma Center

Background Pediatric traumatic brain injury (TBI) affects about 475,000 children in the United States annually. Studies from the 1990s showed worse mortality in pediatric TBI patients not transferred to a pediatric trauma center (PTC), but did not examine mild pediatric TBI. Evidence-based guidelines used to identify children with clinically insignificant TBI who do not require head CT were developed by the Pediatric Emergency Care Applied Research Network (PECARN). However, which patients can be safely observed at a non-PTC is not directly addressed. Methods A systematic review of the literature was conducted, focusing on management of pediatric TBI and transfer decisions from 1990 to 2020. Results Pediatric TBI patients make up a great majority of preventable transfers and admissions, and comprise a significant portion of avoidable costs to the health care system. Majority of mild TBI patients admitted to a PTC following transfer do not require ICU care, surgical intervention, or additional imaging. Studies have shown that as high as 83% of mild pediatric TBI patients are discharged within 24 hrs. Conclusions An evidence-based clinical practice algorithm was derived through synthesis of the data reviewed to guide transfer decision. The papers discussed in our systematic review largely concluded that transfer and admission was unnecessary and costly in pediatric patients with mild TBI who met the following criteria: blunt, no concern for NAT, low risk on PECARN assessment, or intermediate risk on PECARN with negative imaging or imaging with either isolated, nondisplaced skull fractures without ICH and/or EDH, or SDH <0.3 cm with no midline shift.

Effects of Pediatric Traumatic Brain Injury on Verbal IQ: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Carly A. Cermak ◽  
Shannon E. Scratch ◽  
Nick P. Reed ◽  
Lisa Kakonge ◽  
Deryk S. Beal
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Small Sample ◽  
Extensive Literature ◽  
Pediatric Traumatic Brain Injury ◽  
Mild Tbi ◽  
Verbal Iq ◽  
Statistical Heterogeneity

Abstract Objectives: To examine the effects of pediatric traumatic brain injury (TBI) on verbal IQ by severity and over time. Methods: A systematic review and subsequent meta-analysis of verbal IQ by TBI severity were conducted using a random effects model. Subgroup analysis included two epochs of time (e.g., <12 months postinjury and ≥12 months postinjury). Results: Nineteen articles met inclusion criteria after an extensive literature search in MEDLINE, PsycInfo, Embase, and CINAHL. Meta-analysis revealed negative effects of injury across severities for verbal IQ and at both time epochs except for mild TBI < 12 months postinjury. Statistical heterogeneity (i.e., between-study variability) stemmed from studies with inconsistent classification of mild TBI, small sample sizes, and in studies of mixed TBI severities, although not significant. Risk of bias on estimated effects was generally low (k = 15) except for studies with confounding bias (e.g., lack of group matching by socio-demographics; k = 2) and measurement bias (e.g., outdated measure at time of original study, translated measure; k = 2). Conclusions: Children with TBI demonstrate long-term impairment in verbal IQ, regardless of severity. Future studies are encouraged to include scores from subtests within verbal IQ (e.g., vocabulary, similarities, comprehension) in addition to functional language measures (e.g., narrative discourse, reading comprehension, verbal reasoning) to elucidate higher-level language difficulties experienced in this population.

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