Traumatic Brain & Central Nervous System Injury - The Eastern Association for the Surgery of Trauma

Skip to main content

Eastern Association for the Surgery of Trauma

Traumatic Brain & Central Nervous System Injury

1 pageviews

Outcomes of civilian pediatric craniocerebral gunshot wounds: A systematic review

Duda T, Sharma A, Ellenbogen Y, Martyniuk A, Kasper E, Engels P, Sharma S.

J Trauma Acute Care Surg . 2020 Aug 3.

Rationale for inclusion: Systematic review of the literature on craniocerebral gunshot wounds in pediatric patients up to age 18. Despite its limitations, this study offers the key takeaway that more than half of pediatric patients with this devastating injury survived, and more than a quarter of them with good functional recovery. Aggressive management of pediatric patients with the devastating mechanism of "GSW to the head" is indicated.

CAVEAT: Review of a relatively small number of cases with high risk for bias due to heterogeneity and varying quality of included studies.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Predictors for Pediatric Blunt Cerebrovascular Injury (BCVI): An International Multicenter Analysis.

Weber CD, Lefering R, Weber MS, Bier G, Knobe M, Pishnamaz M, Kobbe P, Hildebrand F; TraumaRegister DGU.

World J Surg. 2019 Sep;43(9):2337-2347.

Rationale for inclusion: BCVI remains a controversial topic in adult trauma and there is even less clarity in pediatric patients. This database analysis includes more than 8,000 pediatric trauma patients and demonstrates a low incidence (0.5%) but devastating consequences in this patient population, as well as risk factors.

CAVEAT: Retrospective database analysis; imaging practices in this European study might not mirror practices in the US

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.

Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA, Turner M, Benzel EC, Suskauer SJ, Giza CC, Joseph M, Broomand C, Weissman B, Gordon W, Wright DW, Moser RS, McAvoy K, Ewing-Cobbs L, Duhaime AC, Putukian M, Holshouser B, Paulk D, Wade SL, Herring SA, Halstead M, Keenan HT, Choe M, Christian CW, Guskiewicz K, Raksin PB, Gregory A, Mucha A, Taylor HG, Callahan JM, DeWitt J, Collins MW, Kirkwood MW, Ragheb J, Ellenbogen RG, Spinks TJ, Ganiats TG, Sabelhaus LJ, Altenhofen K, Hoffman R, Getchius T, Gronseth G, Donnell Z, O'Connor RE, Timmons SD.

JAMA Pediatr. 2018 Nov 1;172(11):e182853.

Rationale for inclusion: This manuscript is a summary of the Pediatric Mild Traumatic Brain Injury Guideline Workgroup of the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors and is the result of an evidence review was conducted from 1990 through 2015. The guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment

CAVEAT: Guidelines.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study.

Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Jachno K, Ward B, Williams A, Baylis A, Crowe L, Oakley E, Dalziel SR; Paediatric Research in Emergency Departments International Collaborative (PREDICT).

Lancet. 2017 Jun 17;389(10087):2393-2402.

Rationale for inclusion: Multicenter, prospective observational study of children (<18yrs) with head injuries found that PECARN, CATCH and CHALICE rules all effectively identified children with clinically significant head injuries.

CAVEAT: This is not a statistical comparison of these three rules.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension.

Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ; RESCUEicp Trial Collaborators.

N Engl J Med. 2016 Sep 22;375(12):1119-30.

Rationale for inclusion: 408 patients with traumatic intracranial hypertension were randomized to decompressive craniectomy or medical therapy. Decompressive craniectomy resulted in lower mortality but greater vegatitive state and severe disability at 6 months.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department.

Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ.

JAMA Pediatr. 2013 Feb;167(2):156-61.

Rationale for inclusion: In this single-center, retrospective review of a prospective dataset, the authors identified adolescent age, headache on presentation to the ED, and admission to the hospital risk factors for postconcussive syndrome following mild traumatic brain injury. Postconcussive syndrome occurred in 29% of their mild traumatic brain injury population and manifested in a mean of 7.4 missed days of school.

CAVEAT: Single center.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Predictors of cognitive function and recovery 10 years after traumatic brain injury in young children.

Anderson V, Godfrey C, Rosenfeld JV, Catroppa C.

Pediatrics. 2012 Feb;129(2):e254-61.

Rationale for inclusion: In this single center, prospective, longitudinal study, the authors describes the trajectory of cognitive and functional skills following early childhood TB. They found that children with severe TBI had worst outcomes, with deficits greatest for cognition. Recovery trajectories were similar across severity groups but with significant gains in verbal skills from 12 and 30 months to 12 months and 10 years. Predictors of outcome included preinjury ability (for adaptive function) and family function (social/behavioral skills). Young children appear to make age-appropriate progress for at least to 10 years after injury. Environmental factors were also found to contribute to adaptive and social/behavioral recovery.

CAVEAT: Single center.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition.

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS, Warden CR; American Academy of Pediatrics-Section on Neurological Surgery; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Child Neurology Society; European Society of Pediatric and Neonatal Intensive Care; Neurocritical Care Society; Pediatric Neurocritical Care Research Group; Society of Critical Care Medicine; Paediatric Intensive Care Society UK; Society for Neuroscience in Anesthesiology and Critical Care; World Federation of Pediatric Intensive and Critical Care Societies.

Pediatr Crit Care Med. 2012 Jan;13 Suppl 1:S1-82.

Rationale for inclusion: These guidelines provide extensive, evidence based recommendations for the management of traumatic brain injury in children. They are broadly endorsed by major neurosurgery, neurology, pediatric, and critical care professional societies.

CAVEAT: Guidelines

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Autologous bone marrow mononuclear cell therapy for severe traumatic brain injury in children.

Cox CS Jr, Baumgartner JE, Harting MT, Worth LL, Walker PA, Shah SK, Ewing-Cobbs L, Hasan KM, Day MC, Lee D, Jimenez F, Gee A.

Neurosurgery. 2011 Mar;68(3):588-600.

Rationale for inclusion: In this study, the authors show that bone marrow harvest and intravenous mononuclear cell infusion as treatment for severe TBI in children is logistically feasible and safe. Ten children with a severe traumatic brain injury were treated with autologous bone marrow-derived mononuclear cells within 48 hours after TBI. All patients survived and there were no episodes of harvest-related depression of systemic or cerebral hemodynamics and there was no detectable infusion-related toxicity. cMRI imaging comparing gray matter, white matter, and CSF volumes showed no reduction from 1 to 6 months postinjury and dichotomized Glasgow Outcome Score at 6 months showed 70% with good outcomes and 30% with moderate to severe disability.

CAVEAT: Single center, feasability/safety.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL; Pediatric Emergency Care Applied Research Network (PECARN).

Lancet. 2009 Oct 3;374(9696):1160-70.

Rationale for inclusion: This prospective, multicenter, observational study of 42,412 pediatric trauma pateints with head injury and GCS of 14-15 validated a clnical prediction rule that identifield children at low risk of clinically-important traumatic brain injury for which head CT could be safely avoided.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Hypothermia therapy after traumatic brain injury in children.

Hutchison JS, Ward RE, Lacroix J, Hébert PC, Barnes MA, Bohn DJ, Dirks PB, Doucette S, Fergusson D, Gottesman R, Joffe AR, Kirpalani HM, Meyer PG, Morris KP, Moher D, Singh RN, Skippen PW; Hypothermia Pediatric Head Injury Trial Investigators and the Canadian Critical Care Trials Group.

N Engl J Med. 2008 Jun 5;358(23):2447-56.

Rationale for inclusion: This randomized, prospective, multi-center, multinational trial of 225 patients showed that hypothermia initiated within 8 hours of injury and continued for 24 hours did not improve neurologic outcome and could worsen mortality.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients.

MRC CRASH Trial Collaborators, Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S, Roberts I, Shakur H, Steyerberg E, Yutthakasemsunt S.

BMJ. 2008 Feb 23;336(7641):425-9.

Rationale for inclusion: Original study of CRASH data that allowed for prediction of outcome of brain injury from presentation exam and CT. Predictive model/calculator that can be used in trauma bay to determine longterm outcome after brain injury, validated multiple times since then.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Guidelines for prehospital management of traumatic brain injury 2nd edition.

Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, Jernigan S, Letarte PB, Lerner EB, Moriarty TM, Pons PT, Sasser S, Scalea T, Schleien CL, Wright DW; Brain Trauma Foundation; BTF Center for Guidelines Management.

Prehosp Emerg Care. 2008;12 Suppl 1:S1-52.

Rationale for inclusion: This supplement of Prehospital Emergency Care presents comprehensive, evidence guidelines for the prehospital management of children with traumatic brain injury.

CAVEAT: Guidelines

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Hyperglycemia and outcomes from pediatric traumatic brain injury.

Cochran A, Scaife ER, Hansen KW, Downey EC.

J Trauma. 2003 Dec;55(6):1035-8.

Rationale for inclusion: This retrospective, single center review of pediatric patients with severe TBI showed that hyperglycemia is associated with poor neurologic outcome.

CAVEAT: Single center, retrospective

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

A population-based study of inflicted traumatic brain injury in young children.

Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH.

JAMA. 2003 Aug 6;290(5):621-6.

Rationale for inclusion: This study of 230,000 children aged 2 years and younger showed a higher risk of inflicted traumatic brain injury in males, children of young mothers, non-European Americans, products of multiple births, and younger infants. This paper helped to define risk factors for inflicted traumatic brain injury.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

A prospective study of short- and long-term outcomes after traumatic brain injury in children: behavior and achievement.

Taylor HG, Yeates KO, Wade SL, Drotar D, Stancin T, Minich N.

Neuropsychology. 2002 Jan;16(1):15-27.

Rationale for inclusion: This longitudinal study across four years of behavior and achievement in children with severe traumatic brain injury (N=53), moderate traumatic brain injury (N=56), and controls (N=80, orthopedic injuries) showed persistent sequelae of traumatic brain injury. The study also showed that post-injury improvement can be influenced by the family environment.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension.

Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J.

Childs Nerv Syst. 2001 Feb;17(3):154-62.

Rationale for inclusion: This single center, prospective, randomized trial of 27 childrens sustaining severe TBI compared compared medical management plus decompressive craniectomy to medical management alsona. They found that early decompressive craniectomy improves intracranial pressure and epidodes of intracranial hypertension with improved long term neurologic outcome.

CAVEAT: Single Center

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Hypertonic saline lowers raised intracranial pressure in children after head trauma.

Fisher B, Thomas D, Peterson B.

J Neurosurg Anesthesiol. 1992 Jan;4(1):4-10.

Rationale for inclusion: This prospective, double blind, crossover study evaluated the impact of 3% saline compared to 0.9% saline. 3% saline infusion significantly reduced ICP after traumatic brain injury in children. This study help define the role of hpertonic salining in the management of pedric TBI.

CAVEAT: Single Center

Citations - To review the number of citations for this landmark paper, visit Google Scholar.