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Pediatric head brain trauma

Erik B Smith, Jennifer K Lee, Monica S Vavilala, Sarah A Lee
Pediatric traumatic brain injury (TBI) uniquely affects the pediatric population. Abusive head trauma (AHT) is a subset of severe pediatric TBI usually affecting children in the first year of life. AHT is a form of nonaccidental trauma. Sports-related TBI resulting in concussion is a milder form of TBI affecting older children. Current recommended perioperative management of AHT and sports concussions relies on general pediatric TBI guidelines. Research into more specific pediatric TBI screening and management goals is ongoing...
March 2019: Anesthesiology Clinics
Hakan Yilmaz, Ozlem Yilmaz
AIM: We investigated the pediatric patients who presented with isolated head trauma to the emergency service and where abnormal findings were detected on brain computed tomography to evaluate the follow-up scan rate and whether the follow-up scans affect the treatment protocol. MATERIAL AND METHODS: Pediatric patients who presented to the emergency service between 2014 and 2017 with isolated head trauma and were later found to have abnormal findings on CT were evaluated...
January 21, 2019: World Neurosurgery
Molly E Hubbard, Abdullah Bin Zahid, Kathleen Vonderhaar, David Freeman, Rachel M Nygaard, Andrew Kiragu, Daniel Guillaume
INTRODUCTION: Traumatic brain injury (TBI) is a major public health problem, particularly in children. Prognostication of injury severity at the time of presentation is difficult. The Abbreviated Injury Scale (AIS) is a commonly used anatomical-based coding system created to classify and describe injury severity after initial presentation, once test results are able to better define the anatomical characteristics of the injury. We hypothesize that the Head AIS can predict discharge destination in children after TBI...
January 19, 2019: Brain Injury: [BI]
Erik P Hess, James L Homme, Anupam B Kharbanda, Leah Tzimenatos, Jeffrey P Louie, Daniel M Cohen, Lise E Nigrovic, Jessica J Westphal, Nilay D Shah, Jonathan Inselman, Michael J Ferrara, Jeph Herrin, Victor M Montori, Nathan Kuppermann
Importance: The Pediatric Emergency Care Applied Research Network prediction rules for minor head trauma identify children at very low, intermediate, and high risk of clinically important traumatic brain injuries (ciTBIs) and recommend no computed tomography (CT) for those at very low risk. However, the prediction rules provide little guidance in the choice of home observation or CT in children at intermediate risk for ciTBI. Objective: To compare a decision aid with usual care in parents of children at intermediate risk for ciTBI...
September 7, 2018: JAMA network open
Pedram Emami, Patrick Czorlich, Friederike S Fritzsche, Manfred Westphal, Johannes M Rueger, Rolf Lefering, Michael Hoffmann
PURPOSE: A Glasgow Coma Scale (GCS) score of 8 or less in patients suffering from severe traumatic brain injury (TBI) represents a decision-making marker in terms of intubation. This study evaluated the impact of prehospital intubation on the mortality of these TBI cases among different age groups. METHODS: This study included the data from patients predominantly suffering from severe TBI [Abbreviated Injury Scale (AIS) of the head ≥ 3, GCS score < 9, Injury Severity Score (ISS) > 9] who were registered in TraumaRegister DGU® from 2002 to 2013...
January 10, 2019: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Mohammad Vafaeeshahi, Nazanin Azizishalbaf, Leila Tahernia
Cerebellar acute ischemic stroke (AIS) can be a complication of minor head trauma, vertebral artery dissection, vasospasm or systemic hypoperfusion. CT scan usually is negative few hours after acute infarction. Magnetic resonance imaging (MRI) is superior to CT scan for posterior fossa lesions and also in acute phase of cerebellar stroke especially in children. Here we report a 9 yr old girl referred to the Pediatric Emergency Room, Moosavi Hospital, Zanjan, Iran in January 2017 presenting with sudden onset of headache and recurrent vomiting, ataxia, and history of 3 consecutive days of fever and malaise...
2019: Iranian Journal of Child Neurology
Dustin W Ballard, Nathan Kuppermann, David R Vinson, Eric Tham, Jeff M Hoffman, Marguerite Swietlik, Sara J Deakyne Davies, Evaline A Alessandrini, Leah Tzimenatos, Lalit Bajaj, Dustin G Mark, Steve R Offerman, Uli K Chettipally, Marilyn D Paterno, Molly H Schaeffer, Rachel Richards, T Charles Casper, Howard S Goldberg, Robert W Grundmeier, Peter S Dayan
STUDY OBJECTIVE: To determine the effect of providing risk estimates of clinically important traumatic brain injuries and management recommendations on emergency department (ED) outcomes for children with isolated intermediate Pediatric Emergency Care Applied Research Network clinically important traumatic brain injury risk factors. METHODS: This was a secondary analysis of a nonrandomized clinical trial with concurrent controls, conducted at 5 pediatric and 8 general EDs between November 2011 and June 2014, enrolling patients younger than 18 years who had minor blunt head trauma...
December 22, 2018: Annals of Emergency Medicine
Kent P Hymel, Ming Wang, Vernon M Chinchilli, Wouter A Karst, Douglas F Willson, Mark S Dias, Bruce E Herman, Christopher L Carroll, Suzanne B Haney, Reena Isaac
BACKGROUND: Evidence-based, patient-specific estimates of abusive head trauma probability can inform physicians' decisions to evaluate, confirm, exclude, and/or report suspected child abuse. OBJECTIVE: To derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients' completed skeletal surveys and retinal exams. PARTICIPANTS AND SETTING: 500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013...
December 11, 2018: Child Abuse & Neglect
(no author information available yet)
OBJECTIVEPediatric traumatic brain injury (TBI) is common, but not all injuries require hospitalization. A computational tool for ruling in patients who will have a clinically relevant TBI (CRTBI) would be valuable, providing an evidence-based way to safely discharge children who are at low risk for a CRTBI. The authors hypothesized that an artificial neural network (ANN) trained on clinical and radiologist-interpreted imaging metrics could provide a tool for identifying patients likely to suffer from a CRTBI...
October 1, 2018: Journal of Neurosurgery. Pediatrics
Divya Gunda, Benjamin O Cornwell, Hisham M Dahmoush, Sammer Jazbeh, Anthony M Alleman
Infants and children under 2 years of age are at greatest risk for devastating neurologic complications following nonaccidental trauma. While a subdural hematoma (SDH) is the most common finding and is often enough to raise suspicion for abuse, no single injury is pathognomonic for abusive head trauma (AHT). Rather, the combination of imaging and physical findings and the clinical presentation help confirm the diagnosis of AHT. Familiarity with the spectrum of findings and proper identification of the imaging abnormalities is important for the radiologist to facilitate treatment and removal of the patient from the abusive environment...
November 23, 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Jeremy D Kauffman, Cristen N Litz, Sasha A Thiel, Anh Thy H Nguyen, Aaron Carey, Paul D Danielson, Nicole M Chandler
BACKGROUND: Degree of compliance with Pediatric Emergency Care Applied Research Network (PECARN) recommendations for radiographic evaluation following minor head injury in children is not well understood. The aim of this study was to assess PECARN compliance at a pediatric trauma center. The secondary aim was to determine whether children with indeterminate history of loss of consciousness (LOC) are at greater risk for clinically important traumatic brain injury (ciTBI) than those with no LOC...
December 2018: Journal of Surgical Research
Omar Z Ahmed, Richard Holubkov, J Michael Dean, Tellen D Bennett, Kathleen L Meert, Robert A Berg, Christopher J L Newth, Joseph Carcillo, Randall S Burd, Murray M Pollack
BACKGROUND: Because pediatric trauma-related mortality continue to decline, metrics assessing morbidity are needed to evaluate the impact of treatment after injury. Based of its value for assessing children with traumatic brain injuries and other critical illnesses, Functional Status Scale (FSS), a tool that measures function in six domains (communication, feeding, mental, motor, sensory and respiratory), was evaluated as an outcome measure for the overall population of injured children...
November 15, 2018: Journal of Trauma and Acute Care Surgery
Melissa S Puffenbarger, Fahd A Ahmad, Michelle Argent, Hongjie Gu, Charles Samson, Kimberly S Quayle, Jacqueline M Saito
OBJECTIVE: The purpose of this study was to determine if implementation of a Pediatric Emergency Care Applied Research Network (PECARN)-based closed head injury assessment tool could safely decrease computed tomography (CT) use for pediatric head injury evaluation at a non-pediatric community emergency department (ED). METHODS: A quality improvement project was initiated at a non-pediatric community ED to implement an institution-specific, Pediatric Emergency Care Applied Research Network (PECARN)-based Pediatric Closed Head Injury Assessment Tool...
November 14, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Krishnamoorthy Thamburaj, Ajay Soni, Lori D Frasier, Kyaw N Tun, Sarah R Weber, Mark S Dias
BACKGROUND: Retinal hemorrhages are one of the most important supportive evidences for abusive head trauma (AHT). Susceptibility-weighted imaging (SWI) is highly suited to identify various forms of intracranial hemorrhage in AHT. However its utility in imaging retinal hemorrhage is not well established. OBJECTIVE: SWI is a sensitive sequence for identifying retinal hemorrhage on MRI. MATERIALS AND METHODS: In this retrospective analysis, 26 consecutive infants and young children with a suspected admission diagnosis of AHT underwent indirect ophthalmoscopy and brain MRI protocol for AHT along with SWI...
February 2019: Pediatric Radiology
Abdulaziz O Almubarak, Abdulkarim S Al-Rabie, Rawan M Alsolami, Mohammaed M Homoud
Leptomeningeal cysts, which are cystic collections filled with cerebrospinal fluid, are rare complications following pediatric head trauma and surgical correction of craniosynostosis. These cysts develop due to cerebrospinal fluid pulsations and brain growth that cause expansion of the dural tears. Although primary repair of the dural defect is the definitive treatment, the risk of cyst recurrence remains. Factors that increase this risk include syndromic craniosynostosis, hydrocephalus, increased intracranial pressure, and inadequate duraplasty/cranioplasty...
October 2018: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
Guilherme Gozzoli Podolsky-Gondim, Luciano Lopes Furlanetti, Dinark Conceição Viana, Matheus Fernando Manzolli Ballestero, Ricardo Santos de Oliveira
INTRODUCTION: Head injury is a significant economic, social, and medical problem in developing countries and remains one of the leading causes of pediatric morbidity and mortality. The association of traumatic brain injury and coagulopathy in children is linked with an increase in mortality and poor functional outcomes. However, its impact on long-term outcome has not been discussed in the literature so far. OBJECTIVES: The aim of this paper was to investigate the effect of coagulopathy diagnosed by routine laboratory tests on neurological outcome following traumatic brain injury in children...
December 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Christopher W Snyder, Jeremy D Kauffman, Etienne E Pracht, Paul D Danielson, David J Ciesla, Nicole M Chandler
BACKGROUND: Effective and sustainable pediatric trauma care requires systems of regionalization and interfacility transfer. Avoidable transfer, also known as secondary overtriage, occurs when a patient is transferred to a regional trauma center after initial evaluation at another facility that is capable of providing definitive care. The purpose of this study was to identify risk factors for avoidable transfer among pediatric trauma patients in southwest Florida. METHODS: All pediatric trauma patients two years and older transferred from outlying hospitals to the emergency department (ED) of a single state-designated pediatric trauma center between 2009 and 2017 were obtained from the institutional registry...
October 11, 2018: Journal of Trauma and Acute Care Surgery
Fadi Al Daoud, Anne Drolet, Chase Carto, Haben Debessai, Gul Sachwani Daswani
Introduction: Traumatic Brain Injuries (TBIs) can range from mild to severe, and may result in increased intracranial pressure (ICP). Increased ICP causes hallmark physical signs, such as diaphoresis, emesis, fixed pupils, and altered mental status. Monitoring the patient's score on the Glasgow Coma Scale (GCS) and cranial CT scans are routine measures used in clinical practice to monitor the development of a TBI. Presentation of the case: A 6-year-old male fell off his father's shoulders and subsequently presented to ED for suspected head trauma...
November 2018: Annals of Medicine and Surgery
William T O'Brien, Marguerite M Caré, James L Leach
Pediatric head trauma is an important cause of morbidity and mortality in children and may be seen in the setting of accidental or abusive injuries. Although many of the patterns of head injury are similar to adults, the imaging manifestations of head injury in children are more complex due to the developing brain and calvarium. Additionally, there are unique considerations for mechanisms of injury in children, to include abusive head trauma and birth-related injuries. The primary role of the radiologist is to identify and characterize the type and severity of head injury to help guide appropriate patient management...
October 2018: Seminars in Ultrasound, CT, and MR
Ruth M Masterson Creber, Peter S Dayan, Nathan Kuppermann, Dustin W Ballard, Leah Tzimenatos, Evaline Alessandrini, Rakesh D Mistry, Jeffrey Hoffman, David R Vinson, Suzanne Bakken
BACKGROUND:  The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma. OBJECTIVE:  This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country...
July 2018: Applied Clinical Informatics
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