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Object Traumatic brain injury (TBI) is a leading cause of injury, hospitalization, and death among pediatric patients. Admission CT scans play an important role in classifying TBI and directing clinical care, but little is known about the differences in CT findings between pediatric and adult patients. The aim of this study was to determine if radiographic differences exist between adult and pediatric TBI. Methods The authors retrospectively analyzed TBI registry data from 1206 consecutive patients with nonpenetrating TBI treated at a Level 1 adult and pediatric trauma center over a 30-month period. Results The distribution of sex, race, and Glasgow Coma Scale (GCS) score was not significantly different between the adult and pediatric populations; however, the distribution of CT findings was significantly different. Pediatric patients with TBI were more likely to have skull fractures (OR 3.21, p < 0.01) and epidural hematomas (OR 1.96, p < 0.01). Pediatric TBI was less likely to be associated with contusion, subdural hematoma, subarachnoid hemorrhage, or compression of the basal cisterns (p < 0.05). Rotterdam CT scores were significantly lower in the pediatric population (2.3 vs 2.6, p < 0.001). Conclusions There are significant differences in the CT findings in pediatric versus adult TBI, despite statistical similarities with regard to clinical severity of injury as measured by the GCS. These differences may be due to anatomical characteristics, the biomechanics of injury, and/or differences in injury mechanisms between pediatric and adult patients. The unique characteristics of pediatric TBI warrant consideration when formulating a clinical trial design or predicting functional outcome using prognostic models developed from adult TBI data.

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Background: Pediatric spinal deformity surgeries are challenging operations that require considerable expertise and resources. The unique anatomy and rarity of these cases present challenges in surgical training and preparation. We present a case series illustrating how 3-dimensional (3-D) printed models were used in preoperative planning for 3 cases of pediatric spinal deformity surgery. Case Series: Patient 1 was a 6-year-old male with scoliosis secondary to an L3 hemivertebra and severe congenital heart disease who underwent excision of the L3 hemivertebra and L2-L4 spinal fusion. Patient 2 was an 11-year-old male with an L2 hemivertebra and lumbar kyphosis who underwent excision of the L2 hemivertebra and T12-L4 spinal fusion. Patient 3 was a 6-year-old female with Down syndrome who presented with atlantoaxial instability and acute lymphoblastic leukemia. She underwent occipitalcervical spinal fusion and decompression. Prior to surgery, 3-D printed models of the patients' spines were created based on computed tomography (CT) imaging. Conclusion: The anatomic complexity and risk of devastating neurologic consequences in spine surgery call for careful preparations. 3-D models enable more efficient and precise surgical planning compared to the use of 2-dimensional CT/magnetic resonance images. The 3-D models also make it easier to visualize patient anatomy, allowing patients and their families who lack medical training to interpret and understand cross-sectional anatomy, which in our experience, enhanced the consultations.

Study Objective To compare neurological outcomes at six months in older patients with pre-injury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage (tICH) to those without prior use of these medications. Methods This was a retrospective study conducted at a Level 1 trauma center from April 2009 to July 2010. Patients over 55 years of age with isolated mild head injury (Glasgow Coma Scale Score [GCS] 13 to 15 and Abbreviated Injury Score < 3 in non-head body region) were included. Demographic, clinical, and outcome data were abstracted from an existing TBI database. The primary endpoint of unfavorable extended Glasgow Outcome Score (GOS-E) at 6 months was compared between patients with and without pre-injury warfarin or clopidogrel use. Results Seventy-seven eligible patients were identified; 27 (35%) with pre-injury warfarin or clopidogrel use and 50 (65%) without. Baseline characteristics (gender, GCS score, Injury Severity Score, computed tomography score, and in-hospital mortality) were similar between cohorts although the pre-injury warfarin or clopidogrel cohort was older than the control group (p<.05). Patients in the pre-injury warfarin or clopidogrel cohort were more likely to have an unfavorable outcome (16/27; 59.3%, 95% confidence interval [CI] 40.7–77.8%) as compared to those without (18/50; 36.0%, 95% CI 22.7–49.3%), p=.05. Conclusion Older adults with pre-injury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage may be at an increased risk for unfavorable long-term neurological outcomes compared to similar patients without pre-injury use of these medications.