Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

Jagannathan, Jay; Okonkwo, David O.; Yeoh, Hian K.; Dumont, Aaron S.; Saulle, Dwight; Haizlip, Julie; Barth, Jeffrey T.; Jane, John A.

doi:10.3171/ped.2008.2.10.240

Cited by 123 publications

(66 citation statements)

References 46 publications

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“…That the study group so defined was "severe" is supported by the overall mortality rate of 24%, which is comparable to mortality rates for severe TBI among children defined by GCS or AIS scores in contemporary case series and prospective trials. 2,9,11,17,24,25,34,35,39,40,43,44,46,47 Nevertheless, the rate of neurosurgical procedures in the current study group (46.8%) was unexpectedly low. Even among admissions lasting 2 days or longer and ending in death, the rate of neurosurgical procedures was only 67.3%.…”

Section: The Missing Icp Monitorsmentioning

confidence: 80%

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Piatt

Neff

2012

PED

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Object The goal in this paper was to study hospital care for childhood traumatic brain injury (TBI) in a nationwide population base. Methods Data were acquired from the Kids' Inpatient Database (KID) for the years 1997, 2000, 2003, 2006, and 2009. Admission for TBI was defined by any ICD-9-CM diagnostic code for TBI. Admission for severe TBI was defined by a principal diagnostic code for TBI and a procedural code for mechanical ventilation; admissions ending in discharge home alive in less than 4 days were excluded. Results Estimated raw and population-based rates of admission for all TBI, for severe TBI, for death from severe TBI, and for major and minor neurosurgical procedures fell steadily during the study period. Median hospital charges for severe TBI rose steadily, even after adjustment for inflation, but estimated nationwide hospital charges were stable. Among 14,932 actual admissions for severe TBI captured in the KID, case mortality was stable through the study period, at 23.9%. In a multivariate analysis, commercial insurance (OR 0.86, CI 0.77–0.95; p = 0.004) and white race (OR 0.78, CI 0.70–0.87; p < 0.0005) were associated with lower mortality rates, but there was no association between these factors and commitment of resources, as measured by hospital charges or rates of major procedures. Increasing median income of home ZIP code was associated with higher hospital charges and higher rates of major and minor procedures. Only 46.8% of admissions for severe TBI were coded for a neurosurgical procedure of any kind. Fewer admissions were coded for minor neurosurgical procedures than anticipated, and the state-by-state variance in rates of minor procedures was twice as great as for major procedures. Possible explanations for the “missing ICP monitors” are discussed. Conclusions Childhood brain trauma is a shrinking sector of neurosurgical hospital practice. Racial and economic disparities in mortality rates were confirmed in this study, but they were not explained by available metrics of resource commitment. Vigilance is required to continue to supply neurosurgical expertise to the multidisciplinary care process.

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Section: The Missing Icp Monitorsmentioning

confidence: 80%

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Piatt

Neff

2012

PED

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“…7 The outcomes of patients with inflicted head injuries were compared with those with other mechanisms of closed head injury, after correcting for such well-recognized confounding factors as initial GCS score after injury, preoperative ICP, time to decompressive craniectomy, and the presence and degree of systemic injuries (none of which differed significantly between our 2 groups of patients). 13,21 The finding that GCS scores did not differ significantly between our patients with accidental trauma and those with nonac- cidental trauma may simply reflect the reduced reliability of GSC scores in younger children. A poor outcome (KOSCHI category 1, 2, or 3) was found in 57% of our patients with nonaccidental trauma but only 30% of those with other mechanisms of injury, although this difference was not statistically significant (p = 0.17).…”

Section: (86%)mentioning

confidence: 81%

“…An alternative welldescribed scale, which has been used extensively by other researchers, is the GOS. 20,21,23 We used the KOSCHI, however, because it is a specific pediatric adaptation of the GOS and is reported to have more sensitivity at the milder end of the disability range. 7 The outcomes of patients with inflicted head injuries were compared with those with other mechanisms of closed head injury, after correcting for such well-recognized confounding factors as initial GCS score after injury, preoperative ICP, time to decompressive craniectomy, and the presence and degree of systemic injuries (none of which differed significantly between our 2 groups of patients).…”

Section: (86%)mentioning

confidence: 99%

“…24 Reports predominantly dealing with adult patients have described the results from decompressive craniectomy done late in the course of refractory intracranial hypertension, and some of these have suggested that early decompressive craniectomy can result in more favorable outcomes. 16,32 Other reports have addressed outcomes following decompressive craniectomy in children with TBI, 1,12,21,23,25,37 and a significant proportion of these patients were victims of abusive head trauma. decompressive craniectomy, in children with TBI and compares cases involving abusive head trauma with those involving other mechanisms of injury.…”

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confidence: 99%

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Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma

Oluigbo¹,

Wilkinson²,

Stence³

et al. 2012

PED

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Object The goal of this study was to compare clinical outcomes following decompressive craniectomy performed for intracranial hypertension in children with nonaccidental, blunt cranial trauma with outcomes of decompressive craniectomy in children injured by other mechanisms. Methods All children in a prospectively acquired database of trauma admissions who underwent decompressive craniectomy over a 9-year span, beginning January 1, 2000, are the basis for this study. Clinical records and neuroimaging studies were systematically reviewed. Results Thirty-seven children met the inclusion criteria. Nonaccidental head trauma was the most common mechanism of injury (38%). The mortality rate in patients with abusive brain injury (35.7%) was significantly higher (p < 0.05) than in patients with other causes of traumatic brain injury (4.3%). Children with inflicted head injuries had a 12-fold increase in the odds of death and 3-fold increase in the odds of a poor outcome (King's Outcome Scale for Closed Head Injury score of 1, 2, or 3). Conclusions Children with nonaccidental blunt cranial trauma have significantly higher mortality following decompressive craniectomy than do children with other mechanisms of injury. This understanding can be interpreted to mean either that the threshold for decompression should be lower in children with nonaccidental closed head injury or that decompression is unlikely to alter the path to a fatal outcome. If decompressive craniectomy is to be effective in reducing mortality in the setting of nonaccidental blunt cranial trauma, it should be done quite early.

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“…The overarching benefit of early hemicraniectomy is that uncontrollable increased ICP can be thwarted prior to loss of autoregulation, thereby reducing overall mortality. 8 Unfortunately, the neurocognitive sequela secondary to increased ICP exists on a continuum of severity, and it is nearly impossible to determine the quality of life a patient might experience after a hemicraniectomy. Many believe the cons of early hemicraniectomy are centered on these perceived ideas of a poor quality of life after recovery.…”

Section: Discussionmentioning

confidence: 99%

Survival following decompressive hemicraniectomy for hemiconvulsion-hemiplegia-epilepsy syndrome: case report

Beier

Jannotta

Sandler³

et al. 2016

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Hemiconvulsion-hemiplegia-epilepsy (HHE) is an uncommon epileptic syndrome that affects young children. Typical management includes early initiation of benzodiazepines to abate the initial seizure activity quickly. Patients in whom epilepsy develops require prolonged use of antiepileptic agents. Herniation due to diffuse cerebral edema from HHE is rare; however, decompressive craniectomy has been described as a lifesaving measure. The authors present the case of a patient in whom a decompressive craniectomy was performed. They advocate a proactive approach in the detection and management of cerebral edema in HHE causing intracranial hypertension. In HHE cases that exhibit radiographic evidence of malignant cerebral edema (although not previously described in this disease, but similar to the setting of stroke and trauma), the authors advocate early neurosurgical consultation and evaluation for insertion of an intracranial pressure monitor for those patients who do not have a reliable neurological examination (i.e., Glasgow Coma Scale score ≤ 8).

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Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

Cited by 123 publications

References 46 publications

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective

Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma

Survival following decompressive hemicraniectomy for hemiconvulsion-hemiplegia-epilepsy syndrome: case report

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