Traumatic Brain Injury In Children Research Articles

Do preinjury life events moderate the outcomes of mild traumatic brain injuries in children? An A-CAP Study.

To examine preinjury life events as moderators of postconcussive symptoms (PCS) and quality of life (QoL) in children with pediatric mild traumatic brain injury (mTBI) versus orthopedic injury (OI). Participants were 633 children with mTBI and 334 with OI, ages 8-16.99, recruited from 5 pediatric emergency departments and followed for 6 months postinjury as part of a prospective cohort study. Preinjury life events were measured retrospectively using the Child and Adolescent Survey of Experiences, PCS using the Health and Behavior Inventory (HBI) and Post-Concussion Symptom Interview (PCS-I), and QoL using the Pediatric Quality of Life Inventory (PedsQL). Analyses involved longitudinal regression using restricted cubic splines, with group, positive and negative life events, and time as primary predictors. Covariates included age, sex, race, socioeconomic status, preinjury history (i.e., headache, migraine, previous concussion), and parent-rated retrospective PCS-I, HBI, and PedsQL scores. PCS and QoL were worse after mTBI than OI, but group differences declined with time (all p < .001). Group differences in PCS were larger at higher levels of positive life events, which predicted lower PCS (p= .03 to p < .001) and higher QoL (p = .048) after OI but not after mTBI. Negative life events predicted worse PCS and QoL in both groups (p = .002 to p < .001). Preinjury positive life events moderate outcomes after pediatric injury, with a protective effect seen in OI but not in mTBI. Negative life events are consistently associated with worse outcomes regardless of injury type.

Long-term burden of informal caregiver 7-years after severe childhood traumatic brain injury in the traumatisme grave de l’Enfant (TGE) study

ABSTRACT Objective To investigate reported burden by the Primary Family Caregiver (PFC) 7-years after severe pediatric traumatic brain injury in the TGE (Traumatisme Grave de l’Enfant) longitudinal study. Methods Subjective burden was estimated with the Zarit Burden Inventory (ZBI) in 36 PFC (parents), who rated their own health status (Medical Outcome Study Short Form-12), family functioning and their child’s level of care and needs (Pediatric/Adult Care And Needs Scale [PCANS/CANS]). Data collection included: child and PFC sociodemographic characteristics, injury-related factors, ‘objective’ (e.g. overall level of disability: Glasgow Outcome Scale – Extended, GOS-E/GOS-E-Peds) and ‘subjective’ outcomes (e.g. participation, behavior, executive functions, quality of life and fatigue). Results 25% of PFC reported mild-moderate burden, and 19% moderate-severe burden. Higher burden correlated with worse outcomes in all ‘subjective’ PFC-rated outcomes, and with self-reported participation. The ZBI correlated strongly with CANS/PCANS and GOS-E/GOS-E-Peds. Overall level of disability and PFC-reported executive functioning explained 62% of the ZBI variance. For equal levels of disability, burden was higher when PFC reported a ‘negative’ picture of their child. Conclusion Significant PFC-reported burden 7-years post-injury was associated with overall disability and ‘subjective’ PFC-rated outcomes. Factors influencing parental burden in the long term should be identified and psychological support implemented over time.

How significant is the BIG score in childhood traumatic brain injury?

This study aims to evaluate the reliability of the BIG score in predicting mortality in children with traumatic brain injury (TBI) and to compare it with the literature and other scoring systems. Patients who were followed up in the Pediatric Intensive Care Unit (PICU) for TBI between 2014 and 2019 in a tertiary reference hospital were evaluated retrospectively. One hundred fifty-nine patients met the inclusion criteria. The most common injury mechanisms were falling from a height (39.6%). The mortality rate was 12.6% (n = 20). The mean BIG score, ISS, and PRISM III were statistically significantly higher in the mortality group (p < 0.001). The AUC values found in the ROC analysis in the whole study group, respectively, 0.962 (CI 0.920-0.986) for the BIG score, 0.952 (CI 0.906-0.979) for the ISS, 0.957 (CI 0.913-0.983) for the GCS, and 0.981 (CI 0.946-0.996) for the PRISM III. In the patients with isolated TBI, the AUC value for the BIG score was 0.988 (0.967-1.000) and higher than the ISS and PRISM 3 [0.983 (0.956-1.000), 0.969 (0.932-1.000) respectively]). The cut-off point for the BIG score in the whole group was 19 (sensitivity 95%, specificity 88%, positive predictive value 0.58, negative predictive value 0.99). In logistic regression model, we found that BIG score is an independent variable for mortality (AOR:1.4, 95%CI 1.22-1.63). In children with traumatic brain injury, the BIG score is simple, quickly calculated, and a good predictor of mortality and disease severity. Prospective studies with more extensive series are needed on this subject.

Cortisol dynamics, quality of life and fatigue following traumatic brain injury in childhood.

Traumatic brain injury (TBI) is a leading cause of acquired neurological morbidity. The prevalence of post-traumatic hypopituitarism (PTHP) and associated morbidity after childhood TBI is unclear. Our study investigated long term HPA (hypothalamus-pituitary-adrenal) axis function, in a prospective childhood TBI and control cohort, using measures of cortisol/cortisone secretion (physiological, stimulated), HPA axis feedback and exploring associations with fatigue, depression and Quality of Life (QoL) outcomes. All TBI participants had data concerning severity and mechanism of TBI. All groups had clinical assessment, pituitary/brain MRI, questionnaire measures of QoL, fatigue, depression and salivary cortisone profiles including dexamethasone suppression test. In addition participants with Moderate/Severe TBI had ethical approval for baseline endocrine blood tests, overnight 12-hour venous sampling of cortisol and growth hormone, and stimulated HPA axis evaluation with an insulin tolerance test (ITT). Seventy-two participants with moderate/severe (n=31, age 19.8±4.2 years) or mild TBI (n=24, age 17.8±5.1 years) and matched controls (n=17, age 18.5±5.5 years) took part. Time post TBI was 6.8-10.8 years. Baseline endocrine tests confirmed normal thyroid and posterior pituitary function. One female with moderate/severe TBI had hypogonadism. Pituitary neuroimaging was normal in all participants. In 2/25 ITT and 9/22 overnight serum profiles peak cortisol was <500nmol/l. The two participants with suboptimal ITT cortisol response (392 and 483nmol/L) also had low peak spontaneous serum levels (227 and 447nmol/L respectively). Salivary cortisone profiles showed preservation of HPA axis circadian rhythm and suppression with dexamethasone in all but one TBI participant. TBI participants had higher morning salivary cortisone levels compared to controls. Fatigue was reported by 20/46 TBI participants but only 1/14 controls. Fatigue was not associated with stimulated (ITT) or spontaneous (overnight profile) cortisol, however one TBI participant with severe fatigue had a suboptimal ITT cortisol response. Specific QoL attributes of health state (cognition, memory) were impaired in TBI participants compared to controls. Although not as prevalent as previously reported, HPA axis dysfunction does occur in survivors of childhood TBI confirming the need for endocrine surveillance. However, in most of our paediatric TBI survivors assessed 7-11 years post-TBI, HPA function and circadian rhythmicity was preserved or had recovered. Chronic fatigue is a common concern post TBI but in the majority not associated with frank HPA axis dysfunction. Morning salivary cortisone levels were higher in TBI survivors, (who have a high prevalence of fatigue) compared to healthy controls, despite the recognised association of chronic fatigue with cortisol hyposecretion.

Autologous bone marrow mononuclear cells to treat severe traumatic brain injury in children.

Autologous bone marrow mononuclear cells (BMMNCs) infused after severe traumatic brain injury have shown promise for treating the injury. We evaluated their impact in children, particularly their hypothesized ability to preserve the blood-brain barrier and diminish neuroinflammation, leading to structural central nervous system preservation with improved outcomes. We performed a randomized, double-blind, placebo-sham-controlled Bayesian dose-escalation clinical trial at 2 children's hospitals in Houston, TX and Phoenix, AZ, USA (NCT01851083). Patients 5-17 years of age with severe traumatic brain injury (Glasgow Coma Scale ≤ 8) were randomized to BMMNC or placebo (3:2). Bone marrow harvest, cell isolation, and infusion were completed by 48 hours post-injury. Bayesian continuous reassessment method was used with cohorts of size 3 in the BMMNC group to choose the safest between 2 doses. Primary endpoints were quantitative brain volumes using magnetic resonance imaging and microstructural integrity of the corpus callosum (CC; diffusivity and edema measurements) at 6 months and 12 months. Long-term functional outcomes and ventilator days, intracranial pressure monitoring days, intensive care unit days, and therapeutic intensity measures were compared between groups. Forty-seven patients were randomized, with 37 completing 1-year follow-up (23 BMMNC, 14 placebo). BMMNC treatment was associated with an almost 3-day (23%) reduction in ventilator days, 1-day (16%) reduction in intracranial pressure monitoring, and 3-day (14%) reduction in intensive care unit (ICU) days. White matter volume at 1 year in the BMMNC group was significantly preserved compared to placebo (decrease of 19891 vs 40491, respectively; mean difference of -20600, 95% CI: -35868 to -5332; P = 0.01), and the number of CC streamlines was reduced more in placebo than BMMNC, supporting evidence of preserved CC connectivity in the treated groups (-431 streamlines placebo vs. -37 streamlines BMMNC; mean difference of -394, 95% CI: -803 to 15; P = 0.055), but this did not reach statistical significance due to high variability. We conclude that autologous BMMNC infusion in children within 48 hours after severe traumatic brain injury is safe and feasible. Our data show that BMMNC infusion led to 1) shorter intensive care duration and decreased ICU intensity; 2) white matter structural preservation; and 3) enhanced CC connectivity and improved microstructural metrics.

[The use of transcranial micropolarization in the acute period of severe traumatic brain injury in children].

To assess the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in children. The study on the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in 85 children, divided into 2 groups, was carried out. The study group (42 patients) received the transcranial micropolarization on the 2nd day after severe traumatic brain injury. The control group (43 patients) received only rehabilitation in neurosurgery department. The neurological status in the patients of both groups was assessed on the 2nd day after severe traumatic brain injury in resuscitation department, and after 1, 3 and 6 months. The inclusion of transcranial micropolarization in the early medical rehabilitation of children with severe traumatic brain injury increases consciousness level in a shorter period of time, that predicts early patient's socialization.

Delineating the impact of childhood traumatic brain injury (TBI) on long-term depressive symptom severity: Does sub-acute brain morphometry prospectively predict 2-year outcome?

Despite evidence of a link between childhood TBI and heightened risk for depressive symptoms, very few studies have examined early risk factors that predict the presence and severity of post-injury depression beyond 1-year post injury. This longitudinal prospective study examined the effect of mild-severe childhood TBI on depressive symptom severity at 2-years post-injury. It also evaluated the potential role of sub-acute brain morphometry and executive function (EF) in prospectively predicting these long-term outcomes. The study involved 81 children and adolescents with TBI, and 40 age-and-sex matched typically developing (TD) controls. Participants underwent high-resolution structural magnetic resonance imaging (MRI) sub-acutely at five weeks post-injury (M = 5.55; SD = 3.05 weeks) and EF assessments were completed at 6-months post-injury. Compared to TD controls, the TBI group had significantly higher overall internalizing symptoms and were significantly more likely to exhibit clinically significant depressive symptoms at 2-year follow-up. The TBI group also displayed significantly lower EF and altered sub-acute brain morphometry in EF-related brain networks, including the default-mode network (DMN), salience network (SN) and central executive network (CEN). Mediation analyses revealed significant indirect effects of CEN morphometry on depression symptom severity, such that lower EF mediated the prospective association between altered CEN morphometry and higher depression symptoms in the TBI group. Parallel mediation analyses including grey matter morphometry of a non-EF brain network (i.e., the mentalising network) were not statistically significant, suggesting some model specificity. The findings indicate that screening for early neurostructural and neurocognitive risk factors may help identify children at elevated risk of depressive symptoms following TBI. For instance, children at greatest risk of post-injury depression symptoms could be identified based in part on neuroimaging of networks implicated in EF and post-acute assessments of executive function, which could support more effective allocation of limited intervention resources.

Cognitive Impairment and Early-onset Cerebral Amyloid Angiopathy in a Middle-aged Man with a History of Childhood Traumatic Brain Injury.

We herein report the a 42-year-old man with early-onset cerebral amyloid angiopathy (CAA) and a history of traumatic brain injury and neurosurgery in childhood. Computed tomography revealed cognitive impairment and recurrent lobar intracerebral hemorrhaging. Magnetic resonance imaging indicated cerebral microbleeds, and Pittsburgh compound B positron emission tomography detected brain amyloid deposition, mainly in the region of trauma and occipital lobes. Interestingly, the patient had no genetic predispositions or relevant family history. This case suggests that a single traumatic brain injury or neurosurgery in childhood can cause early-onset CAA.

Clinical characteristics and associated factors of posttraumatic epilepsy after traumatic brain injury in children: A retrospective case-control study

BackgroundTraumatic brain injury (TBI) affects approximately 69 million individuals annually, often resulting in well-documented complications such as epilepsy. Although numerous studies have been performed on posttraumatic epilepsy (PTE) in adults over the past decade, research on chronic consequences of TBI in children remains limited. Herein, we retrospectively assessed children who had experienced moderate to severe TBI to determine their clinical characteristics and identify associated factors associated with the development of PTE in the pediatric population. MethodsThe study population comprised children aged 0–18 years who had experienced moderate to severe TBI and underwent treatment at the Children's Hospital of Chongqing Medical University between 2011 and 2021. They were categorized into two groups: the PTE group, comprising individuals diagnosed with PTE within a one-year follow-up period, and the nPTE group, consisting of those who did not develop PTE during the same timeframe. The primary objective was to investigate the clinical characteristics and identify related associated factors. The relationship between various clinical factors and the incidence of PTE was assessed through univariate and multivariate logistic regression. ResultsA total of 132 patients were assessed. Most participants were male (65%) and the age distribution skewed towards younger children, with a median age of 41.0 months (interquartile range: 45.3). Upon their last clinical visit, 64 children (49%) were diagnosed with PTE. Notably, the first posttraumatic seizure predominantly occurred within the first week following the traumatic event. Further analyses revealed that increasing injury severity, as indicated by a lower Glasgow Coma Scale (GCS) score (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.54–1.12, p= 0.018), a contusion load ≥3 (OR: 8.1, 95% CI: 2.3–28.9, p= 0.001), immediate posttraumatic seizures (IPTS) (OR: 8.9, 95% CI: 2.5–31.2, p < 0.001), and early posttraumatic seizures (EPTS) (OR: 54, 95% CI: 11–276, p < 0.001), were all significantly associated with a higher risk of developing PTE. ConclusionThis study highlights that the onset of PTE was associated with the markers of injury severity or PTS and identified GCS scores, contusion loads of ≥3, IPTS, and EPTS as independent associated factors significantly associated with the development of PTE.

New Functional Impairment After Hospital Discharge by Traumatic Brain Injury Mechanism in Younger Than 3 Years Old Admitted to the PICU in a Single Center Retrospective Study.

Children who suffer traumatic brain injury (TBI) are at high risk of morbidity and mortality. We hypothesized that in patients with TBI, the abusive head trauma (AHT) mechanism vs. accidental TBI (aTBI) would be associated with higher frequency of new functional impairment between baseline and later follow-up. Retrospective single center cohort study. Children younger than 3 years old admitted with TBI to the PICU at a level 1 trauma center between 2014 and 2019. None. Patient characteristics, TBI mechanism, and Functional Status Scale (FSS) scores at baseline, hospital discharge, short-term (median, 10 mo [interquartile range 3-12 mo]), and long-term (median, 4 yr [3-6 yr]) postdischarge were abstracted from the electronic health record. New impairment was defined as an increase in FSS greater than 1 from baseline. Patients who died were assigned the highest score (30). Multivariable logistic regression was performed to determine the association between TBI mechanism with new impairment. Over 6 years, there were 460 TBI children (170 AHT, 290 aTBI), of which 13 with AHT and four with aTBI died. Frequency of new impairment by follow-up interval, in AHT vs. aTBI patients, were as follows: hospital discharge (42/157 [27%] vs. 27/286 [9%]; p < 0.001), short-term (42/153 [27%] vs. 26/259 [10%]; p < 0.001), and long-term (32/114 [28%] vs. 18/178 [10%]; p < 0.001). Sensory, communication, and motor domains were worse in AHT patients at the short- and long-term timepoint. On multivariable analysis, AHT mechanism was associated with greater odds (odds ratio [95% CI]) of poor outcome (death and new impairment) at hospital discharge (4.4 [2.2-8.9]), short-term (2.7 [1.5-4.9]), and long-term timepoints (2.4 [1.2-4.8]; p < 0.05). In patients younger than 3 years old admitted to the PICU after TBI, the AHT mechanism-vs. aTBI-is associated with greater odds of poor outcome in the follow-up period through to ~5 years postdischarge. New impairment occurred in multiple domains and only AHT patients further declined in FSS over time.

Comprehensive assessment of executive functioning following childhood severe traumatic brain injury: clinical utility of the child executive functions battery

ObjectivesTo perform a detailed description of executive functioning following moderate-to-severe childhood traumatic brain injury (TBI), and to study demographic and severity factors influencing outcome.MethodsA convenience sample of children/adolescents aged 7–16 years, referred to a rehabilitation department after a TBI (n = 43), was compared to normative data using a newly developed neuropsychological test battery (Child Executive Functions Battery—CEF-B) and the BRIEF.ResultsPerformance in the TBI group was significantly impaired in most of the CEF-B subtests, with moderate to large effect sizes. Regarding everyday life, patients were significantly impaired in most BRIEF clinical scales, either in parent or in teacher reports. Univariate correlations in the TBI group did not yield significant correlations between the CEF-B and socio-economic status, TBI severity, age at injury, or time since injury.ConclusionExecutive functioning is severely altered following moderate-to-severe childhood TBI and is best assessed using a combination of developmentally appropriate neuropsychological tests and behavioral ratings to provide a comprehensive understanding of children’s executive functions.

O069 Links between sleep outcomes and lifestyle factors in young adults who sustained traumatic brain injury in childhood

Abstract Objective We investigated the relationships between subjective and objective sleep and lifestyle factors (i.e., nap duration, screentime, chronotype, use of tobacco, alcohol, caffeine, and medications) in young adults who sustained traumatic brain injury (TBI) in childhood. Methods We report cross-sectional data collected at 20 years post-childhood TBI, as part of a prospective study. Participants included 54 young adults with TBI (Mean age, 27.7years) who were assessed at 20 years postinjury (mild (n = 14), moderate (n = 27), and severe (n = 13) TBI) and 13 healthy controls (Mean age, 26.0 years). The Pittsburgh Sleep Quality Index and actigraphy were used to assess sleep outcomes, and lifestyle factors were assessed with study-designed measures. Results Results showed that poor subjective sleep quality was significantly associated with evening chronotype (p &amp;lt; 0.001) and tobacco use (p &amp;lt; 0.001), while being a parent (p = 0.038) and alcohol use (p = 0.035) were significantly associated with poorer objective sleep efficiency in the TBI group. Discussion These preliminary findings highlight interesting associations between poor sleep quality and lifestyle factors in young adults who sustained TBI in childhood, and indicate the need to further explore these relationships in this TBI population to inform on potential avenues for sleep interventions.

A - 140 Relationships between Childhood Traumatic Brain Injury and Impulsivity, Aggression, and Incarceration in Adulthood.

A traumatic brain injury (TBI) can lead to impaired self-regulatory behaviors such as impulsivity, aggression, and poor decision making. It was hypothesized that childhood TBI would relate to higher impulsivity, aggression, and incarceration in adulthood. The current study analyzes an archival dataset of 95 incarcerated men from a correctional facility. Composite scores were created for impulsivity self-report, impulsivity neurobehavioral, and aggression. The measures used to assess each of these were Barkley Adult ADHD Rating Scale, Dysexecutive Questionnaire, Triarchic Psychopathic Measure Disinhibition scale and Meanness scale, Porteous Maze Task, Color-Word Interference Test, Aggression Questionnaire, and Institutional records. Hypothesis testing was based on a series of analyses of covariance. Age was entered as the covariate for all analyses. Non-significant effects were observed between TBI with LOC before the age of 15 and impulsivity, F(1, 82) = 0.59, p = 0.45, ηp2 = 0.007;, F(1, 84) = 0.13, p = 0.72, ηp2 = 0.002, aggression, F(1, 83) = 0.27, p = 0.60, ηp2 = 0.003, and adult incarceration, F(1, 78) = 0.76, p = 0.39, ηp2 = 0.01. The covariate of age was found to be statistically significant with a medium effect in the incarceration model, F(1, 78) = 11.44, p = 0.001, ηp2 = 0.13. Prior literature provides support for the hypotheses even though the results of this study didn't. With greater research on TBI in childhood, we can discover and implement strategies to help children after they have had a TBI to boost development and prevent potential negative outcomes.

1.16 Novel Psychiatric Disorder 12 months After Traumatic Brain Injury in Children and Adolescents

1.16 Novel Psychiatric Disorder 12 months After Traumatic Brain Injury in Children and Adolescents

A Retrospective Cohort Study of Traumatic Brain Injury in Children: A Single-Institution Experience and Determinants of Neurologic Outcome

Abstract Introduction Traumatic brain injury (TBI) has become a significant cause of death and morbidity in childhood since the elucidation of infectious causes within the last century. Mortality rates in this population decreased over time due to developments in technology and effective treatment modalities. Aim of the study This retrospective cohort study aimed to describe the volume, severity and mechanism of all hospital-admitted pediatric TBI patients at a university hospital over a 5-year period. Material and Methods This was a single-center, retrospective cohort study including 90 pediatric patients with TBI admitted to a tertiary care PICU. The patients’ demographic data, injury mechanisms, disease and trauma severity scores, initiation of enteral nutrition and outcome measures such as hospital stay, PICU stay, duration of mechanical ventilation, mortality, and Glasgow Outcome Scale (GOS) were also recorded. Late enteral nutrition was defined as initiation of enteral feeding after 48 hours of hospitalization. Results Of the 90 patients included in the cohort, 60% had mild TBI, 21.1% had moderate TBI and 18.9% had severe TBI. Their mean age was 69 months (3–210 months). TBI was isolated in 34 (37.8%) patients and observed as a part of multisystemic trauma in 56 (62.2%). The most commonly involved site in multisystemic injury was the thorax (33.3%). The length of hospitalization in the late enteral nutrition group was significantly higher than that in the early nutrition group, while the PICU stay was not significantly different between the two groups. The multiple logistic regression analysis found a significant relationship between GOS-3rd month and PIM3 score, the presence of diffuse axonal injury and the need for CPR in the first 24 h of hospitalization. Conclusion Although our study showed that delayed enteral nutrition did not affect neurologic outcome, it may lead to prolonged hospitalization and increased hospital costs. High PIM3 scores and diffuse axonal injury are both associated with worse neurologic outcomes.

Age and anatomical-functional nuances of traumatic brain injury in children

The purpose. Traumatic brain injury in children is a serious medical problem that requires special attention and research. As the child's body develops and grows, the anatomical and functional characteristics of children can affect the pathological consequences of traumatic brain injury. Given the growing number of children who are injured in sports events, accidents and other factors, understanding the characteristics of this category of injury can play an important role in improving their treatment and rehabilitation. Children respond to injury differently than adults and may exhibit different symptoms and require specialized medical care and approaches to treatment and rehabilitation. Understanding these age and anatomical and functional differences can help improve the diagnosis and treatment of brain injury in children and increase their chances of full recovery and normal development. Materials and methods. 154 charts of inpatients aged from 1 month to 17 years who were receiving inpatient treatment at the regional children's hospital during 2022 were analyzed. The basic methods of examination were radiographs, MRI of the brain.Research results. The most craniocerebral traumas were observed in children aged 7-17 years, which constituted 47.4%. Children aged 3-6 were often injured, accounting for almost 20%, older children (15-17 years old) were injured less often, accounting for 15%. Babies under one year old (9.7%) and children under 2 years old (8.4%) suffered the least amount of damage. The largest number of injured children (60.4%) was observed in the warm season when they are active outside without proper parental supervision.Conclusions. The largest number of brain injuries is characteristic of adolescence, against the background of changes in all body systems, the formation of new behavioral reactions for them, which were not characteristic of them before, and contribute to the increase in traumatism. Babies suffered the least damage, which is due to the anatomical features of the structure of the child's head.

Educational and employment outcomes associated with childhood traumatic brain injury in Scotland: A population-based record-linkage cohort study

ObjectivesTraumatic brain injury (TBI) is a leading cause of death and disability among young children and adolescents and the effects can be lifelong and wide-reaching. This study aimed to compare the educational and employment outcomes of Scottish schoolchildren previously hospitalised for TBI with their peers.&#x0D; MethodsA retrospective, record-linkage population cohort study was conducted using linkage of health and education administrative records. The cohort comprised all 766,244 singleton children born in Scotland and aged between 4 and 18 years who attended Scottish schools at some point between 2009 and 2013. Outcomes included special educational need (SEN), examination attainment, school absence and exclusion, and unemployment. Logistic regression models and generalised estimating equation (GEE) models were run unadjusted and then adjusted for sociodemographic and maternity confounders.&#x0D; ResultsOf the 766,244 children in the cohort, 4,788 (0.6%) had a history of hospitalisation for TBI. Following adjustment for potential confounders, previous TBI was associated with SEN (OR 1.28, CI 1.18 to 1.39, p &lt; 0.001), absenteeism (IRR 1.09, CI 1.06 to 1.12, p &lt; 0.001), exclusion (IRR 1.33, CI 1.15 to 1.55, p &lt; 0.001), and low attainment (OR 1.30, CI 1.11 to 1.51, p &lt; 0.001). There was no significant association with unemployment 6 months after leaving school (OR 1.03, CI 0.92 to 1.16, p = 0.61). Excluding hospitalisations coded as concussion strengthened the associations.&#x0D; ConclusionChildhood TBI, sufficiently severe to warrant hospitalisation, was associated with a range of adverse educational outcomes. These findings reinforce the importance of preventing TBI where possible. Where not possible, children with a history of TBI should be supported to minimise the adverse impacts on their education.

Survival and Functional Outcome in Children with Traumatic Brain Injury Requiring Ventilatory Support: A Prospective Observational Pilot Study

Abstract Background In children, incidence of traumatic brain injury is high and identifying predictors of poor outcome can help clinicians make decisions in the acute phase of treatment. We thus planned to analyze the survival and functional outcome of children following traumatic brain injury. Our study included children (1–10 years of age) requiring ventilation and admitted to trauma intensive care unit of our hospital following traumatic brain injury. Our primary aim was to determine patient outcome using the modified Glasgow Outcome Scale at 3 months following hospital discharge. Our secondary objectives included patient outcome at 1 month following discharge and factors which may affect outcome. Methods Data (epidemiological, clinical, radiological data, and hospital course) of possible factors affecting survival and outcome of pediatric traumatic brain injury patients were collected. Patient outcome was determined using the modified Rankin Scale at the time of hospital discharge and modified Glasgow Outcome Scale at 1and 3 months following discharge. Results At the time of hospital admission, 60% children had a Glasgow Coma Scale score of 3 to 8, and were admitted with severe head injury. At the time of discharge, 30% children had good functional outcome, with 50 and 58% children being functionally independent at 1 and 3 months following discharge, respectively. Deranged serum sodium level was an independent predictor of poor neurological outcome on multivariate analysis (coefficient: −3.90 [−5.14 to –2.66, p &lt; 0.001]). Conclusion Fifty-eight percent children, who were admitted to intensive care unit for mechanical ventilatory support, were functionally independent at the end of 3 months following discharge from the hospital, with modified Glasgow Outcome Scale score of 5 or “Normal.” Deranged electrolytes result in secondary brain injury, thus contributing to poor long-term outcome. Effective electrolyte management is essential to improve outcome after traumatic brain injury in children.

External Validation of a Clinical Nomogram for Predicting Intracranial Hematoma Following Head Computed Tomography in Pediatric Traumatic Brain Injury

Abstract Introduction Over-investigation of head computed tomography (CT) has been observed in children with TBI. Long-term effects from a head CT brain scan have been addressed and those should be balanced. A nomogram is a simple prediction tool that has been reported for predicting intracranial injuries following a head CT of the brain in TBI children in literature. This study aims to validate the performance of the nomogram using unseen data. Additionally, the secondary objective aims to estimate the net benefit of the nomogram by decision curve analysis (DCA). Methods We conducted a retrospective cohort study with 64 children who suffered from traumatic brain injury (TBI) and underwent a CT of the brain. Nomogram's scores were assigned according to various variables in each patient; therefore sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and F1 score were estimated by the cross-tabulation of the actual results and the predicted results. Additionally, the benefits of a nomogram were compared with “None” and “All” protocols using DCA. Results There were 64 children with TBI who underwent a head CT in the present study. From the cross-tabulation, the nomogram had a sensitivity of 0.60 (95%CI 0.29–0.90), specificity of 0.96 (0.91–1.0), PPV of 0.75 (0.44–1.0), NPV of 0.92 (0.86–0.99), accuracy of 0.90 (0.83–0.97), and an F1 score of 0.66 (0.59–0.73). Also, the area under the curve was 0.78 which was defined as acceptable performance. For the DCA at 0.1 high-risk threshold, the net benefit of the nomogram was 0.75, whereas the “All” protocol had the net benefit of 0.40 which was obviously different. Conclusion A nomogram is a suitable method as an alternative prediction tool in general practice that has advantages over other protocols.

Factors associated with the development of sequelae due to traumatic brain injury in children under 15 years old: a retrospective cohort study in a hospital in Medellín, Colombia. 2010–2014

Introducción: el trauma craneoencefálico es una de las principales causas de morbimortalidad infantil en Colombia, sus secuelas impactan gravemente la calidad de vida de los pacientes y la evidencia científica actual de los factores asociados al trauma es escasa. Objetivo: analizar los factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años que consultaron a un hospital de Medellín entre 2010 y 2014. Materiales y métodos: estudio de cohorte retrospectivo. Se incluyeron 812 pacientes en un periodo de 5 años, de los cuales 294 no cumplieron los criterios de inclusión. Se evaluaron variables sociodemográficas, clínicas y se estimó la incidencia de secuelas con el método estadístico de Wilson. El riesgo relativo se calculó mediante regresión log-binomial. Resultados: en total se analizaron 518 pacientes. La mediana de edad fue de 5 años, el 64,3 % eran hombres, el 75,4 % de los participantes tenía un trauma leve y el 5 % un trauma grave. Las caídas fueron la principal causa (64,2 %), seguidas de los accidentes de tránsito (25,3 %). La incidencia de secuelas fue del 7.3 % (IC: 5,4 % – 9,9 %). Conclusiones: la carga de enfermedad en el paciente posterior a TCE representa un problema de salud pública. La probabilidad de desarrollar una secuela en este estudio fue del 7,3 %, la cual se relaciona con los siguientes factores que se identifican en el servicio de urgencias: lesión difusa, una escala de Glasgow al ingreso moderada o grave y sufrir un accidente de tránsito.