NDLI: Management of children with mild traumatic brain injury and intracranial hemorrhage.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Greenberg, Jacob K. Stoev, Ivan T. Park, Tae Sung Smyth, Matthew D. Leonard, Jeffrey R. Leonard, Julie C. Pineda, Jose A. Limbrick, David D.
Description	Author Affiliation: Greenberg JK ( From the Departments of Neurological Surgery (J.K.G., I.T.S., T.S.P., M.D.S., J.R.L., D.D.L.), and Pediatrics (T.S.P., M.D.S., J.R.L., J.C.L., J.A.P., D.D.L.), Washington University, St. Louis, Missouri.)
Abstract	BACKGROUND: Traumatic brain injury (TBI) is a significant public health problem affecting tens of thousands of children each year, and an important subset of these patients sustains intracranial hemorrhage (ICH). The purpose of this study was to test the hypothesis that we could identify a subset of children with traumatic ICH who could be monitored on a general neurosurgery ward with a low risk of clinical deterioration. METHODS: We performed a retrospective review of pediatric patients 18 years or younger with mild TBI (Glasgow Coma Scale [GCS] score 14-15) and traumatic ICH admitted to Saint Louis Children's Hospital between 2006 and 2011. We excluded patients with injuries unrelated to the TBI that would require intensive care unit (ICU) admission and those with penetrating intracranial injuries. RESULTS: We identified 118 patients meeting inclusion criteria. Repeat neuroimaging was obtained in 69 (58%) of 118 patients. Radiologic progression was noted in 6 (8.7%) of 69 patients, with a trend toward more frequent progression in patients with epidural hematoma (EDH) versus other ICH (3 [20%] of 15 vs. 3 [5.6%] of 54; p = 0.11). Of 118 patients, 8 (6.8%) experienced clinically important neurologic decline (CIND) and 6 (5.1%) required neurosurgical intervention. Both CIND and the need for neurosurgical intervention were significantly higher in patients with EDH (21% each) compared with those with other types of ICH (4% and 2%, respectively) (p = 0.02, p < 0.01). Based on these results, we developed a preliminary management framework to assist in determining which patients can be safely observed on a neurosurgery ward without an ICU admission. Specifically, those patients without EDH, intraventricular hemorrhage, coagulopathy, or concern for a high-risk neurosurgical lesion (e.g., arteriovenous malformation) may be safely observed on the ward. CONCLUSIONS: These results demonstrate that few children with mild TBI and ICH experience CIND and the preliminary framework we developed assists in identifying which patients can safely avoid ICU admission. This framework should be validated prospectively and externally. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.
File Format	HTM / HTML
ISSN	21630755
e-ISSN	21630763
DOI	10.1097/TA.0000000000000155
Journal	Journal of Trauma and Acute Care Surgery
Issue Number	4
Volume Number	76
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2014-04-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Surgery Discipline Traumatology Brain Injuries Surgery Intracranial Hemorrhage, Traumatic Neurosurgical Procedures Adolescent Diagnosis Injury Severity Score Retrospective Studies Risk Factors Trauma Centers Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Surgery Critical Care and Intensive Care Medicine

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Monitoring and prediction of intracranial hypertension in pediatric traumatic brain injury: clinical factors and initial head computed tomography.

The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons.

Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention.

The effect of trauma center care on pediatric injury mortality in California, 1999 to 2011.

Impact of operative intervention delay on pediatric trauma outcomes.

A pediatric massive transfusion protocol.

Successful placement of intracranial pressure monitors by trauma surgeons.

Do inclusive trauma systems improve outcomes after renal trauma?

Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours.

Management of children with mild traumatic brain injury and intracranial hemorrhage.

Similar Documents

Monitoring and prediction of intracranial hypertension in pediatric traumatic brain injury: clinical factors and initial head computed tomography.

The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons.

Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention.

The effect of trauma center care on pediatric injury mortality in California, 1999 to 2011.

Impact of operative intervention delay on pediatric trauma outcomes.

A pediatric massive transfusion protocol.

Successful placement of intracranial pressure monitors by trauma surgeons.

Do inclusive trauma systems improve outcomes after renal trauma?

Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours.

Management of children with mild traumatic brain injury and intracranial hemorrhage.