Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

Tetsuhara, Kenichi; Kaku, Noriyuki; Watanabe, Yuka; Kumamoto, Masaya; Ichimiya, Yuko; Mizuguchi, Soichi; Higashi, Kanako; Matsuoka, Wakato; Motomura, Yoshitomo; Sanefuji, Masafumi; Hiwatashi, Akio; Sakai, Yasunari; Ohga, Shouichi

doi:10.1038/s41598-021-91628-y

Cited by 4 publications

(6 citation statements)

References 38 publications

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“…Of note, they used the modified Alberta Stroke Program Early CT Score with GWR. They explored whether a low score was associated with unfavorable neurologic outcomes and revealed the linear correlation of GWR and the pediatric cerebral performance category scale [ 8 ]. These studies suggest that the GWR may have an association with survival and neurologic outcome.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Significance of Gray to White Matter Ratio after Cardiopulmonary Resuscitation in Children

et al. 2022

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Cardiopulmonary resuscitation (CPR) successfully restores systemic circulation approximately 50% of the time; however, many successfully restored patients have severe neurologic damage. In adults, the gray matter to white matter attenuation ratio (GWR) in brain computed tomography (CT) correlates with the neurologic outcome. However, in children, the clinical significance of GWR still remains unclear. The aim of this study was to evaluate the clinical characteristics of children who underwent CPR for cardiac arrest according to the survival and to demonstrate the differentiation of grey/white matter by Hounsfield units of brain CT and to characterize the attenuations of grey and white matters. Methods: This is a retrospective single-center study. We enrolled those who underwent brain CT within 24 h after return of spontaneous circulation (ROSC) from January 2005 to June 2018. Brain CTs were taken within 24 h of ROSC. We measured the attenuation of grey and white matter in Hounsfield units and calculated GWR. They were compared with healthy controls. Patients were analyzed as follows: survivors vs. non-survivors and better neurologic outcome vs. worse neurologic outcome. Results: Among 100 pediatric patients who had CPR, 56 met inclusion criteria. There were 24 patients who survived and 32 non-survivors. Our study revealed that the incidence of seizure, duration of CPR, and instances of hypothermia were significantly different between survivors and non-survivors. In both survivors and non-survivors, the attenuation of the caudate nucleus, putamen, GWR-basal ganglia, and average GWR were significantly different from controls. In regression analyses, the medial cortex and average GWR were the significant variables to predict survival, and the receiver operating curves revealed areas under curve of 0.733 and 0.666, respectively. Also, the medial cortex 1 was the only variable that predicted the neurologic outcome. Conclusions: There was some predictive survival value of GWR and medial cortex at the centrum semiovale level in early brain CT within 24 h after cardiac arrest. Although we could not find the predictive value of GWR in the neurologic outcome of pediatric patients, we found that the absolute attenuation of the medial cortex was low in patients with worse neurologic outcomes. Further prospective, multicenter studies are needed to determine the predictive value of GWR and the medial cortex.

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Section: Discussionmentioning

confidence: 99%

“…Brain CT is one of the most frequently used diagnostic modalities that can be done immediately after stabilization of vital signs in children as well. There are several studies regarding GWR [ 6 , 7 , 8 ]; however, there are limited data of attenuation measurements of all grey and white matter in survivors and non-survivors.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Gray to White Matter Ratio after Cardiopulmonary Resuscitation in Children

et al. 2022

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“…In our previous study, lower scores (sGWR < 1.14 and mASPECTS < 20) were correlated with worse outcomes [ 6 ]. The present case showed low values of sGWR (1.13) and mASPECTS (2) on admission.…”

Section: Discussionmentioning

confidence: 99%

“…S1 ). The modified sGWR scored 1.13, while mASPECTS gained only 2 points, both suggestive of poor prognosis [ 6 ]. Although decompressive surgery was immediately performed, her systemic conditions became unstable with uncontrollable pulmonary edema.…”

Section: Case Presentationmentioning

confidence: 99%

“…However, only a few reports have demonstrated details in neuroimaging features and clinical outcomes of patients with ICA in early childhood [ 4 , 5 ]. Two neuroimaging parameters, simplified gray matter attenuation-to-white matter attenuation ratio (sGWR) and modified Alberta stroke program early CT score (mASPECTS), are known to be useful for quantitatively analyzing parenchymal damages of the brain in children with cardiac arrest [ 6 ]. We thus asked whether these scoring systems might also provide critical values for the outcome of ICA in early childhood.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative indices for an intracranial aneurysm and subarachnoid hemorrhage in early childhood: a case report

et al. 2022

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Background Intracranial aneurysms (ICA) rarely occur in children under 3 years of age. Little is known for neuroimaging parameters that predict survival and clinical outcomes of patients with ICA in early childhood. Case presentation A 2-year-old girl showed intracranial hemorrhage due to a rupture of aneurysm at the middle cerebral artery. Quantitative measurements of ischemic damages on the head computed tomography (CT) marked an extremely low score of 2 points with modified Alberta Stroke Program Early CT Score (mASPECTS). She died 15 days after admission. In publications from 2021 to 2022, we found 21 children who were under 3 years of age at onset of ICA. None of them died, but two of three patients who had mASPECTS scores 0–8 showed developmental delay and/or epilepsy as neurological complications. Conclusion Early CT findings are applicable for predicting survival and neurological outcomes of young children with intracranial hemorrhage.

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The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

et al. 2022

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As survival after pediatric intensive care unit (PICU) admission has improved over recent years, a key focus now is the reduction of morbidities and optimization of quality of life for survivors. Neurologic disorders and direct brain injuries are the reason for 11-16% of admissions to PICU. In addition, many critically ill children are at heightened risk of brain injury and neurodevelopmental difficulties affecting later life, e.g., complex heart disease and premature birth. Hence, assessment, monitoring and protection of the brain, using fundamental principles of neurocritical care, are crucial to the practice of pediatric intensive care medicine. The assessment of brain function, necessary to direct appropriate care, is uniquely challenging amongst children admitted to the PICU. Challenges in assessment arise in children who are unstable, or pharmacologically sedated and muscle relaxed, or who have premorbid abnormality in development. Moreover, the heterogeneity of diseases and ages in PICU patients, means that high caliber evidence is harder to accrue than in adult practice, nonetheless, great progress has been made over recent years. In this 'state of the art' paper about critically ill children, we discuss 1) patient types at risk of brain injury, 2) new standardized clinical assessment tools for age-appropriate, clinical evaluation of brain function, 3) latest evidence related to cranial imaging, non-invasive and invasive monitoring of the brain, 4) the concept of childhood 'post intensive are syndrome' and approaches for neurodevelopmental follow up. Better understanding of these concepts is vital for taking PICU survivorship to the next level.

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Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

Cited by 4 publications

References 38 publications

Clinical Significance of Gray to White Matter Ratio after Cardiopulmonary Resuscitation in Children

Clinical Significance of Gray to White Matter Ratio after Cardiopulmonary Resuscitation in Children

Quantitative indices for an intracranial aneurysm and subarachnoid hemorrhage in early childhood: a case report

The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

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