Abstract Details

Title Risk Stratification for Neuroimaging in Pediatric Traumatic Brain Injury

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P06 - (-)

Poster/Presentation
Number 233

Objective

Background BACKGROUND: With the growing concern for excessive radiation exposure to the brain particularly in children, there is a need for studies that examine predictive factors with the goal of developing risk stratification models.

Design/Methods DESIGN/METHODS: This was an IRB approved observational cohort study (n=966) in which school aged children (4-17) were enrolled if they had sustained a head injury within the prior 24 hours. Data were input into RedCap, and JMP 9,0 for the mac were used to perform statistical analyses.

Results RESULTS: 70% of the cohort got a head CT, and it was abnormal in 31%. Three percent required surgical intervention, while 25% required hospital admission, 13% of which required the ICU. Abnormal CT findings: Extracalvarial Swelling 108 (16%) Fracture of Skull 105 (16%) Fracture of Maxillo-facial bones 39 (6%) Fracture of Nasal Bone 16 (2%) Calvarial Fracture through Carotid canal or foramen magnum 9 (1%) Subfalcine Herniation 6 (1%) Downward transtentorial Herniation 10 (2%) Uncal Heniation 5 (1%) Tonsillar herniation 5 (1%) Epidural Hematoma 27 (4%) Subdural Hematoma 32 (5%) Subarachnoid Hemorrhage 32 (5%) Intraventricular Hemorrhage 4 (1%) Parenchymal or Hemorrhagic contusion 54 (8%) Diffuse Axonal Injury 8 (1%) In multivariate regression analysis (fit least squares), post traumatic amnesia (PTA) was significantly associated with both having an abnormal head CT (p=0.0296) as well as needing neurosurgical intervention (p=0.104). The presence of loss of consciousness was also significantly associated with neurosurgical intervention (p=0.133).

Conclusions CONCLUSIONS: Positive neuroimaging findings in pediatric TBI are not uncommon, therefore obtaining prompt imaging is important. Given the concern of radiation to young brain, it may be helpful to look for factors such as PTA or LOC which appear to be significantly associated with having an abnormal head CT for which surgical intervention is often required.

Authors/Disclosures
PRESENTER	No disclosure on file
Aakash N. Bodhit, MD (Dignity Health-St. Mary's Health Center)	No disclosure on file
Yasamin Daneshvar, BA	No disclosure on file
	No disclosure on file
Neil Jouvenat II (University of Nebraska Medical Center/Nebraska Medicine)	No disclosure on file
Bayard D. Miller, MD	No disclosure on file
Latha Ganti, MD, MS, MBA, FACEP	Dr. Ganti has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ganti has received publishing royalties from a publication relating to health care.

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