Incidence of Pediatric Traumatic Brain Injury and Associated Hospital Resource Utilization in the United States

Schneier, Andrew J.; Shields, Brenda J.; Hostetler, Sarah Grim; Xiang, Hao; Smith, Gary A.

doi:10.1542/peds.2005-2588

Cited by 370 publications

(242 citation statements)

References 32 publications

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“…1,2 Among children 0-14 years in the United States, TBI results in an estimated 2,600 deaths, 37,000 hospitalizations, and more than 500,000 emergency department (ED) visits. 3,4 Despite the frequency of TBI, its substantial impact on the health of children, and decades of research on the topic, there are no proven effective treatments for TBI.…”

Section: Discussionmentioning

confidence: 99%

“…The goals of this study were to (1) determine the number and clinical characteristics of children with moderate-to-severe TBI at each participating site, (2) determine the timing of patient and guardian arrival to the ED to provide informed consent within the therapeutic windows of different interventions, and (3) describe the heterogeneity of TBIs on computed tomography (CT) scans.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Stanley

Johnson

Vance

et al. 2017

Academic Emergency Medicine

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Objectives: In preparation for a clinical trial of therapeutic agents for children with moderate-to-severe blunt traumatic brain injuries (TBIs) in emergency departments (EDs), we conducted this feasibility study to (1) determine the number and clinical characteristics of eligible children, (2) determine the timing of patient and guardian arrival to the ED, and (3) describe the heterogeneity of TBIs on computed tomography (CT) scans. Methods:We conducted a prospective observational study at 16 EDs of children ≤ 18 years of age presenting with blunt head trauma and Glasgow Coma Scale scores of 3-12. We documented the number of potentially eligible patients, timing of patient and guardian arrival, patient demographics and clinical characteristics, severity of injuries, and cranial CT findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Stanley

Johnson

Vance

et al. 2017

Academic Emergency Medicine

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“…TBI is the leading cause of mortality in children >1 year of age. Hospitalization for pediatric TBI alone accounts for greater than $1 billion in hospital charges annually in the United States [6]. In spite of the importance and the appropriate emphasis on pediatric TBI in the field of pediatric critical care, the acute neurological injuries cared for in the PICU are heterogeneous.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

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Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

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“…TBI is an often devastating health problem associated with a rehabilitative cost of 60 billion dollars annually in the United States (Schneier et al, 2006). TBI may be separated into two distinct physiologic events: (1) the initial biomechanical injury, and (2) secondary injury as a result of biochemical and cellular changes that contribute to ongoing neuronal damage.…”

Section: Introductionmentioning

confidence: 99%

Detrimental Effect of Genetic Inhibition of B-Site App-Cleaving Enzyme 1 on Functional Outcome after Controlled Cortical Impact in Young Adult Mice

Mannix

Zhang

Park

et al. 2011

Journal of Neurotrauma

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Abstractb-Amyloid (Ab) peptides, most notably associated with Alzheimer's disease, have been implicated in the pathogenesis of secondary injury after traumatic brain injury (TBI). A prior study has demonstrated that blocking the b-site amyloid precursor protein (APP)-cleaving enzyme 1 (Bace1) required for production of Ab from APP improved functional and histologic outcomes after controlled cortical impact (CCI) in aged mice. However, the majority of patients with severe TBI are young adults under the age of 40. Prior experimental models have suggested age-dependent differences in Ab clearance, and a recent study in our lab suggests that young animals remediate acute elevations in Ab after CCI better than older animals. We therefore tested the hypothesis that Bace1 deletion in young adult mice would not be protective after CCI. Male Bace1 knockout (Bace1 -/-) and wild-type Bace1 +/+ (C57BL/6) mice (2-3 months old) were subjected to CCI (n = 18-23/group) or sham injury (n = 10-12/group). Functional outcomes were assessed with wire grip (motor) and the Morris water maze (MWM; spatial memory). Soluble Ab levels were assessed at 48 h after CCI. Histopathological outcomes were assessed by lesion and hippocampal volume. Clustered ordinal logistic regression showed overall significant impairment in motor performance in injured Bace1-/-versus Bace1 +/+ animals ( p = 0.003). No significant differences in MWM performance were found on repeated-measures ANOVA ( p = 0.11) between groups. Probe scores were significantly worse in injured Bace1-/-versus Bace1 +/+ mice ( p = 0.0009). Soluble Ab 40 was significantly lower in ipsilateral hemispheres of Bace1 -/-than in Bace1 +/+ animals after CCI (0.9 [IQR 0.88-0.94] pmol/g protein versus 3.8 [IQR 2.4-6.0] pmol/g protein; p = 0.005). Lesion and hippocampal volumes did not differ between injured groups. The data suggest that therapies targeting Bace1 may need to be tailored according to age and injury severity, as their use may exacerbate functional deficits after TBI in younger or less severely injured patients.

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Incidence of Pediatric Traumatic Brain Injury and Associated Hospital Resource Utilization in the United States

Abstract: Pediatric traumatic brain injury is a substantial contributor to the health resource burden in the United States, accounting for more than $1 billion in total hospital charges annually.

Cited by 370 publications

References 32 publications

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Challenges Enrolling Children Into Traumatic Brain Injury Trials: An Observational Study

Pediatric Neurocritical Care

Detrimental Effect of Genetic Inhibition of B-Site App-Cleaving Enzyme 1 on Functional Outcome after Controlled Cortical Impact in Young Adult Mice

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