Pediatric traumatic brain injury and abusive head trauma

Chevignard, Mathilde; Câmara-Costa, Hugo; Dellatolas, Georges

doi:10.1016/b978-0-444-64150-2.00032-0

Cited by 21 publications

(11 citation statements)

References 289 publications

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“…Severe pediatric TBI, defined by a Pediatric Glasgow Coma Scale (Peds-GCS) score ≤ 8 [6], is associated with long-standing neurological, neuropsychological and behavioral impairments, such as sensory-motor deficits, including hemiparesis and cerebellar dysfunction [7], and deficits in language, visual-spatial skills, processing speed, memory, attention, working memory, executive functioning and behavior regulation [8][9][10][11][12][13]. Those deficits are associated with impaired educational achievement [12,[14][15][16][17], reduced participation, and impaired quality of life in the long term [18][19][20][21].…”

Section: Results Of the Traumatisme Grave De L'enfant (Tge) Studymentioning

confidence: 99%

“…Long-term information retrieval seems to be more severely impaired, although all components of memory can be impacted (i.e. encoding, storage, consolidation, and retrieval) [9]. Memory complaints in daily life are extremely frequent after TBI and patients often report accelerated long-term forgetting, which may occur when any of the components of the brain networks involved in long-term memory formation, or their interaction, is disrupted [27][28][29][30][31][32][33].…”

Section: Results Of the Traumatisme Grave De L'enfant (Tge) Studymentioning

confidence: 99%

“…The present work is part of a larger prospective longitudinal study (TGE cohort), aiming at determining overall and specific outcomes following severe childhood TBI (Câmara-Costa et al, 2020;Krasny-Pacini, Chevignard, et al, 2017;Krasny-Pacini et al, 2017;Le Fur et al, 2019;Viot et al, 2019;Neumane et al, 2021;Krasny-Pacini, Francillette, et al, 2017). The TGE study initiated at the Paris 5 University Hospital Necker-Enfants-Malades, and the follow-up was conducted in the Rehabilitation Department for Children with Acquired Neurological Injury in the Saint Maurice Hospitals.…”

Section: Methodsmentioning

confidence: 99%

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Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant study

Câmara-Costa

Viot

Francillette

et al. 2021

Journal of Neuropsychology

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Objective: to explore memory functioning 7-years after severe pediatric TBI, associated factors, and relationships with other outcomes. Method:Children aged 0-15 years (n=65), consecutively admitted over a 3-year period in a single trauma center, who survived after severe non-inflicted TBI, were included in a prospective longitudinal study. Memory assessments were performed 7-years post-injury using the Children's Memory Scale (CMS) or the Wechsler Memory Scale (WMS IV), according to age. The General Memory Score (GMS-7) was the primary outcome.Results: Thirty-seven patients were available for assessment at 7-years post-injury. Mean GMS-7 was in the low average range (M=84.9, SD=12.1). Lower GMS-7 was significantly associated with markers of higher injury severity, such as length of coma. One-year post-injury functional and disability outcomes explained 74% of the variance of GMS-7. Concurrent intellectual ability and type of ongoing education correlated strongly with GMS-7. Age at injury and parental education were not associated with memory outcome. Conclusions:Memory functioning is variable but often strongly impaired several years after severe pediatric TBI, and is mostly related to injury severity, functional outcomes measured 1year post-injury, and concomitant cognitive and educational outcomes. GMS-7 was lower at 7years than one-year post-injury, supporting the importance of long term follow-up.

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Section: Results Of the Traumatisme Grave De L'enfant (Tge) Studymentioning

confidence: 99%

Section: Results Of the Traumatisme Grave De L'enfant (Tge) Studymentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant study

Câmara-Costa

Viot

Francillette

et al. 2021

Journal of Neuropsychology

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“…Such prolonged microglial activation is often associated with negative developmental outcomes, such as chronic behavioral deficits, progressive cortical thickness reduction, decreased corpus callosum area, neurodegeneration, and cognitive deficits ( 24 , 66 – 69 ). In the clinic, behavioral and affective outcomes are exacerbated in patients injured at a younger age; therefore, our study introduces a plausible, microglia-centric reason for this ( 3 , 66 , 70 ).…”

Section: Discussionmentioning

confidence: 97%

Age-At-Injury Influences the Glial Response to Traumatic Brain Injury in the Cortex of Male Juvenile Rats

et al. 2022

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Few translational studies have examined how age-at-injury affects the glial response to traumatic brain injury (TBI). We hypothesized that rats injured at post-natal day (PND) 17 would exhibit a greater glial response, that would persist into early adulthood, compared to rats injured at PND35. PND17 and PND35 rats (n = 75) received a mild to moderate midline fluid percussion injury or sham surgery. In three cortical regions [peri-injury, primary somatosensory barrel field (S1BF), perirhinal], we investigated the glial response relative to age-at-injury (PND17 or PND35), time post-injury (2 hours, 1 day, 7 days, 25 days, or 43 days), and post-natal age, such that rats injured at PND17 or PND35 were compared at the same post-natal-age (e.g., PND17 + 25D post-injury = PND42; PND35 + 7D post-injury = PND42). We measured Iba1 positive microglia cells (area, perimeter) and quantified their activation status using skeletal analysis (branch length/cell, mean processes/cell, cell abundance). GFAP expression was examined using immunohistochemistry and pixel analysis. Data were analyzed using Bayesian multivariate multi-level models. Independent of age-at-injury, TBI activated microglia (shorter branches, fewer processes) in the S1BF and perirhinal cortex with more microglia in all regions compared to uninjured shams. TBI-induced microglial activation (shorter branches) was sustained in the S1BF into early adulthood (PND60). Overall, PND17 injured rats had more microglial activation in the perirhinal cortex than PND35 injured rats. Activation was not confounded by age-dependent cell size changes, and microglial cell body sizes were similar between PND17 and PND35 rats. There were no differences in astrocyte GFAP expression. Increased microglial activation in PND17 brain-injured rats suggests that TBI upregulates the glial response at discrete stages of development. Age-at-injury and aging with an injury are translationally important because experiencing a TBI at an early age may trigger an exaggerated glial response.

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“…Depending on the severity of injury, the data suggest that TBIs significantly impairs neurocognitive processes, including executive functioning (attention, processing) in the pediatric brain [ 15 , 16 ]. The age at which the injury occurs matters, as young children who experience TBI injuries have pronounced developmental disadvantages compared to older counterparts [ 15 , 17 ]. Further evidence suggests that TBIs can impair social cognition in adolescents, which has meaningful implications for the ability to process information, make inferences, and respond appropriately in a social context [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

The epidemiology of pediatric traumatic brain injury presenting at a referral center in Moshi, Tanzania

et al. 2022

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Background Over 95% of childhood injury deaths occur in low- and middle-income countries (LMICs). Patients with severe traumatic brain injury (TBI) have twice the likelihood of dying in LMICs than in high-income countries (HICs). In Africa, TBI estimates are projected to increase to upwards of 14 million new cases in 2050; however, these estimates are based on sparse data, which underscores the need for robust injury surveillance systems. We aim to describe the clinical factors associated with morbidity and mortality in pediatric TBI at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania to guide future prevention efforts. Methods We conducted a secondary analysis of a TBI registry of all pediatric (0–18 years of age) TBI patients presenting to the KCMC emergency department (ED) between May 2013 and April 2014. The variables included demographics, acute treatment and diagnostics, Glasgow Coma Scores (GCSs, severe 3–8, moderate 9–13, and mild 14–15), morbidity at discharge as measured by the Glasgow Outcome Scale (GOS, worse functional status 1–3, better functional status 4–6), and mortality status at discharge. The analysis included descriptive statistics, bivariable analysis and multivariable logistic regression to report the predictors of mortality and morbidity. The variables used in the multivariable logistic regression were selected according to their clinical validity in predicting outcomes. Results Of the total 419 pediatric TBI patients, 286 (69.3%) were male with an average age of 10.12 years (SD = 5.7). Road traffic injury (RTI) accounted for most TBIs (269, 64.4%), followed by falls (82, 19.62%). Of the 23 patients (5.58%) who had alcohol-involved injuries, most were male (3.6:1). Severe TBI occurred in 54 (13.0%) patients. In total, 90 (24.9%) patients underwent TBI surgery. Of the 21 (5.8%) patients who died, 11 (55.0%) had severe TBI, 6 (30.0%) had moderate TBI (GCS 9–13) and 3 (15.0%) presented with mild TBI (GCS>13). The variables most strongly associated with worse functional status included having severe TBI (OR = 9.45) and waiting on the surgery floor before being moved to the intensive care unit (ICU) (OR = 14.37). Conclusions Most pediatric TBI patients were males who suffered RTIs or falls. Even among children under 18 years of age, alcohol was consumed by at least 5% of patients who suffered injuries, and more commonly among boys. Patients becoming unstable and having to be transferred from the surgery floor to the ICU could reflect poor risk identification in the ED or progression of injury severity. The next steps include designing interventions to reduce RTI, mitigate irresponsible alcohol use, and improve risk identification and stratification in the ED.

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Pediatric traumatic brain injury and abusive head trauma

Cited by 21 publications

References 289 publications

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant study

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l’Enfant study

Age-At-Injury Influences the Glial Response to Traumatic Brain Injury in the Cortex of Male Juvenile Rats

The epidemiology of pediatric traumatic brain injury presenting at a referral center in Moshi, Tanzania

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