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.

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.

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 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.

scholarly journals Pathophysiology of Pediatric Traumatic Brain Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Rebecka O. Serpa ◽  
Lindsay Ferguson ◽  
Cooper Larson ◽  
Julie Bailard ◽  
Samantha Cooke ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Population ◽  
Age Groups ◽  
Bimodal Distribution ◽  
The United States ◽  
Research Progress ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pediatric Tbi

The national incidence of traumatic brain injury (TBI) exceeds that of any other disease in the pediatric population. In the United States the Centers for Disease Control and Prevention (CDC) reports 697,347 annual TBIs in children ages 0–19 that result in emergency room visits, hospitalization or deaths. There is a bimodal distribution within the pediatric TBI population, with peaks in both toddlers and adolescents. Preclinical TBI research provides evidence for age differences in acute pathophysiology that likely contribute to long-term outcome differences between age groups. This review will examine the timecourse of acute pathophysiological processes during cerebral maturation, including calcium accumulation, glucose metabolism and cerebral blood flow. Consequences of pediatric TBI are complicated by the ongoing maturational changes allowing for substantial plasticity and windows of vulnerabilities. This review will also examine the timecourse of later outcomes after mild, repeat mild and more severe TBI to establish developmental windows of susceptibility and altered maturational trajectories. Research progress for pediatric TBI is critically important to reveal age-associated mechanisms and to determine knowledge gaps for future studies.

scholarly journals Analytical Study of the Evolution of Hospitalizations for Traumatic Brain Injury In Brazil, In Comparison With Region, Race, Gender, Age Range and Death, Between January 2011 and December 2020

2021 ◽  
Author(s):  
Daniel de Christo Esteves ◽  
Antônio Henrique Roberti dos Santos ◽  
Guilherme Neumann de Araújo ◽  
Mylena Sobreira Sena ◽  
Giovanna Amaral Lopes ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
Public Health Problem ◽  
Age Group ◽  
Important Public Health Problem ◽  
Risk Of Death ◽  
External Agent ◽  
Methods Analytical

Background: Traumatic brain injury (TBI) consists of an damage to the brain tissue by an external agent, whether due to falls, car accidents or aggressions. It is a situation that often requires emergency care, due to possible sequelae and the imminent risk of death. Thus, TCE is one of the main causes of death worldwide, especially in children and young adults, translating into an important public health problem with a high socioeconomic impact. Objectives: To report the number of hospitalizations for TBI, in order to clarify the relationship between it and the variables studied. Methods: Analytical epidemiological study carried out by research at DATASUS based on data on head trauma in Brazil, with patients aged less than 1 year to 80 years or more, between January 2011 and December 2020, associating the location according to the age group, region, race, gender, mortality rate, year and number of deaths in the country. Results: Observing the cases of intracranial trauma, in the last 10 years (2011- 2020), 1,033,512 cases were noted, 787,480 (76.19%) of which were male. As for the regional proportion, there is a higher incidence in the southeastern region, with 431,785 (43.02%) cases, with São Paulo being 236,653 (54.80%) the state with the largest number, followed by the northeast region, in which it occupies the second position with the highest number of cases, with 274,781 (26.58%) and Ceará the most relevant state with 65,602 (23.87%) cases. Regarding race, browns with 348,581 (33.72%) cases had the highest rate. Evaluating an age group, 17.23% of the cases are between 20 and 29 years old, followed by 14.88% between 30 and 39 years old. In relation to deaths, there is a total of 98,537, with the age group between 20 and 29 years with the highest incidence with 14,814 (15.03%), with a highlight in the male gender with 13,152 (88.78%). With regard to the mortality rate, a higher rate was observed in males aged over 80 years. Conclusion: Traumatic brain injury often requires an early diagnosis for a better prognosis. Judging from the large number of cases, it is worth investing in methods for early diagnosis, seeking to improve the prognosis and reduce the total number of deaths. In addition, it is necessary to look at the causes of TBI and to emphasize the prevention of causes that can be avoided, especially among the youngest who are the most affected group.

scholarly journals Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms

2016 ◽  
Vol 2016 ◽  
pp. 1-14 ◽  
Author(s):  
Rahul Singh ◽  
Ryan C. Turner ◽  
Linda Nguyen ◽  
Kartik Motwani ◽  
Michelle Swatek ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Drug Targets ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Autism Spectrum ◽  
Pediatric Traumatic Brain Injury ◽  
Gastrointestinal Problems ◽  
Brain Circuitry ◽  
Pediatric Tbi

Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more rigorous trials that can be used to improve guidelines for pediatric patients suffering from TBI or ASD.

Animal Models of Pediatric Traumatic Brain Injury: Lessons Learned

Neurotrauma ◽  
2018 ◽  
pp. 303-314
Author(s):  
Jimmy W. Huh ◽  
Lauren A. Hanlon ◽  
Ramesh Raghupathi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Animal Models ◽  
Age Groups ◽  
Developmental Time ◽  
Lessons Learned ◽  
White Matter Injury ◽  
Pediatric Traumatic Brain Injury ◽  
Injury Severities ◽  
Pediatric Tbi

A predominant focus of both clinical and preclinical pediatric traumatic brain injury (TBI) research is to combat secondary injury processes in the acute posttraumatic period that may contribute to pathologies that lead to long-term functional impairments. Identified therapeutic targets must undergo rigorous preclinical testing in relevant animal models of pediatric TBI. Animal models for pediatric TBI use injury mechanisms such as fluid-percussion, rotational-acceleration, weight-drop, and controlled cortical impact. These models span species (mice, rats, rabbits and pigs) and several age groups to encompass the developmental time points and utilize various injury severities to reproduce the pathologies such as atrophy, ventriculomegaly, white matter injury, and behavioral impairment. This review focuses on the validation of these preclinical models using clinical observations of structural and functional impairment in the acute and chronic period following TBI. In addition, the limitations of the current animal models are discussed within the context of strategies for further development of clinically relevant outcomes and therapeutic strategies.

A Conceptual Framework of Social Communication: Clinical Applications to Pediatric Traumatic Brain Injury

2020 ◽  
Vol 41 (02) ◽  
pp. 143-160
Author(s):  
Catherine Wiseman-Hakes ◽  
Lisa Kakonge ◽  
Meghan Doherty ◽  
Miriam Beauchamp
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Conceptual Framework ◽  
Social Communication ◽  
Clinical Applications ◽  
Future Research ◽  
Sex And Gender ◽  
Pediatric Traumatic Brain Injury ◽  
Communication Impairments ◽  
Pediatric Tbi

AbstractSocial communication impairments are common following pediatric traumatic brain injury (TBI) and can lead to social isolation, and poor social outcomes. Social communication has been documented as a persistent area of need in terms of proper assessment and intervention; however, this is not consistently addressed in clinical practice. While there is a body of evidence regarding social communication impairments and pediatric TBI, this area is not yet fully understood and remains underrecognized. To meet this gap, we provide a conceptual framework of social communication from a neurodevelopmental perspective, which can be applied to better understand the social communication impairments associated with pediatric TBI. We propose a general model of social communication with component constructs and consideration of internal factors such as sex and gender. These can inform considerations, clinical applications, and future research in assessment and evidence-based interventions within the domain of social communication.

scholarly journals Traumatic brain injury in Brazil: a comparative analysis between deaths and hospitalizations from 2015 to 2019

2021 ◽  
Author(s):  
Mateus Ribeiro de Almeida ◽  
Laila Santos Borges ◽  
Giovana Aquino de Moraes ◽  
Felipe Fróes Batista Ribeiro ◽  
Giovanna Souza Filardi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Public Health Problem ◽  
Descriptive Study ◽  
Progressive Reduction ◽  
Important Public Health Problem ◽  
The North ◽  
Unified Health System ◽  
Great Relevance ◽  
Using Data

Background: Traumatic brain injury (TBI) is a type of head injury with great relevance to the health service, affecting an average of 100,000 Brazilians/year. It’s one of the main causes of trauma morbidity and mortality, becoming an important public health problem. Objectives: Analyze the evolution of deaths, mortality rate (MR) and hospitalizations by TBI in Brazil during 2015-2019. Methods: An epidemiological, retrospective, descriptive study was carried out, using data from the Information Technology Department of the Unified Health System (DATASUS), during 2015-2019. Results: 514,666 hospitalizations and 48,554 deaths from TBI were reported during 2015-2019 in Brazil. In hospitalizations, the year with the highest records was 2015 (20.8%, n=106,980), while the lowest was 2019 (18.3%, n=94,055). There was a progressive reduction in hospitalizations in the period, with a decrease of 12.1% of hospitalizations in the interval. The number of deaths varied from year to year, with peak prevalence in 2016 (21.1%, n=10,264), and a progressive reduction after that year about 15.3% until 2019 (17.9%, n=8,691). Most deaths occurred in the Southeast (45.6%, n=22,144), while the Midwest (6.5%, n=3,169) registered lower rates. However, the highest MR recorded was in the North (MR=6.9), exceeding the national average (MR=6.3) in the period, while the lowest belonged to the South (MR=6.1). Conclusion: Despite the variations between 2015-2019, there was a decrease in deaths and hospitalizations in the period. Deaths were concentrated in Southeast, however, the largest MR was in the North.

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