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Journal of Pediatric Neuroradiology 2016; 05(01): 002-006
DOI: 10.1055/s-0036-1584226
Review Article
Georg Thieme Verlag KG Stuttgart • New York

The Role of Neuroimaging in the Diagnosis, Treatment, and Prognosis of Traumatic Brain Injury in Children

Sarah Murphy
1   Division of Pediatric Critical Care, Harvard University, Boston, Massachusetts, United States
2   Division of Neurosurgery, MassGeneral Hospital for Children, Boston, Massachusetts, United States
,
Ann-Christine Duhaime
1   Division of Pediatric Critical Care, Harvard University, Boston, Massachusetts, United States
2   Division of Neurosurgery, MassGeneral Hospital for Children, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

12 February 2016

12 February 2016

Publication Date:
20 May 2016 (online)

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Abstract

Neuroimaging is a central pillar in the diagnosis, management, prognostication, and research of pediatric traumatic brain injury (TBI). Head computed tomography (CT) is the most readily available and rapid method of acute neuroimaging in emergency departments and it has been viewed as the diagnostic standard. However, concern about excessive and unnecessary radiation exposure in children has led to the development of clinical prediction rules with a goal of limiting excessive CT imaging in children with blunt head trauma. There is a trend toward increased use of structural magnetic resonance imaging (MRI) including tailored rapid techniques, in both acute and follow-up imaging in children. Where available, MRI is more sensitive for parenchymal injury than CT and may fulfill the dual goal of decreasing radiation exposure and increasing the yield of more subtle parenchymal trauma. In the current era of TBI management, the diagnosis and treatment of TBI is driven increasingly by neuroimaging. The ability of neuroimaging to provide multidimensional information, specifically, pathoanatomic classification of injuries, as well as important data on injury evolution over time, is increasingly relied upon to match appropriate treatments to the pathophysiology specific to a given injury profile. When combined with premorbid, acute clinical, biomarker, and genetic data, the hope is that multidimensional characterization of injury will improve current management of children with TBIs as well as stratify patients more effectively for clinical trials in the future.

Keywords

pediatric - neurotrauma - traumatic brain injury - early MRI - “head-injury”
 

  • References

  • 1 Schneier AJ, Shields BJ, Hostetler SG, Xiang H, Smith GA. Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States. Pediatrics 2006; 118 (2) 483-492
    CrossrefPubMedGoogle Scholar
  • 2 Langlois JA, Rutland-Brown W, Thomas KE. The incidence of traumatic brain injury among children in the United States: differences by race. J Head Trauma Rehabil 2005; 20 (3) 229-238
    CrossrefPubMedGoogle Scholar
  • 3 Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics 2004; 114 (3) 633-639
    CrossrefPubMedGoogle Scholar
  • 4 Faul M, Coronado V. Epidemiology of traumatic brain injury. Handb Clin Neurol 2015; 127: 3-13
    PubMedGoogle Scholar
  • 5 Centers for Disease Control and Prevention. Injury Prevention and Control: Data and Statistics (WISQARS), 2010. Available at: http://www.cdc.gov/injury/wisqars/index.html . Accessed December 2, 2012
    PubMedGoogle Scholar
  • 6 Berger RP, Fromkin JB, Stutz H , et al. Abusive head trauma during a time of increased unemployment: a multicenter analysis. Pediatrics 2011; 128 (4) 637-643
    CrossrefPubMedGoogle Scholar
  • 7 Parks SE, Kegler SR, Annest JL, Mercy JA. Characteristics of fatal abusive head trauma among children in the USA: 2003-2007: an application of the CDC operational case definition to national vital statistics data. Inj Prev 2012; 18 (3) 193-199
    CrossrefPubMedGoogle Scholar
  • 8 Bowman SM, Bird TM, Aitken ME, Tilford JM. Trends in hospitalizations associated with pediatric traumatic brain injuries. Pediatrics 2008; 122 (5) 988-993
    CrossrefPubMedGoogle Scholar
  • 9 World Health Organization. Neurological Disorders: Public Health Challenges. 2010: 1-232
    Google Scholar
  • 10 Osifo OD, Iribhogbe PE, Ugiagbe EE. Epidemiology and pattern of paediatric and adolescent trauma deaths in a level 1 trauma centre in Benin city, Nigeria. Injury 2012; 43 (11) 1861-1864
    CrossrefPubMedGoogle Scholar
  • 11 Shao J, Zhu H, Yao H , et al. Characteristics and trends of pediatric traumatic brain injuries treated at a large pediatric medical center in China, 2002-2011. PLoS ONE 2012; 7 (12) e51634
    CrossrefPubMedGoogle Scholar
  • 12 Klimo Jr P, Ragel BT, Jones GM, McCafferty R. Severe pediatric head injury during the Iraq and Afghanistan conflicts. Neurosurgery 2015; 77 (1) 1-7 , discussion 7
    CrossrefPubMedGoogle Scholar
  • 13 Echemendia RJ, Iverson GL, McCrea M , et al. Advances in neuropsychological assessment of sport-related concussion. Br J Sports Med 2013; 47 (5) 294-298
    CrossrefPubMedGoogle Scholar
  • 14 Yeates KO. Mild traumatic brain injury and postconcussive symptoms in children and adolescents. J Int Neuropsychol Soc 2010; 16 (6) 953-960
    CrossrefPubMedGoogle Scholar
  • 15 Gerrard-Morris A, Taylor HG, Yeates KO , et al. Cognitive development after traumatic brain injury in young children. J Int Neuropsychol Soc 2010; 16 (1) 157-168
    CrossrefPubMedGoogle Scholar
  • 16 Ewing-Cobbs L, Prasad MR, Swank P , et al. Social communication in young children with traumatic brain injury: relations with corpus callosum morphometry. Int J Dev Neurosci 2012; 30 (3) 247-254
    CrossrefPubMedGoogle Scholar
  • 17 Koskiniemi M, Kyykkä T, Nybo T, Jarho L. Long-term outcome after severe brain injury in preschoolers is worse than expected. Arch Pediatr Adolesc Med 1995; 149 (3) 249-254
    CrossrefPubMedGoogle Scholar
  • 18 Rivara FP, Koepsell TD, Wang J , et al. Incidence of disability among children 12 months after traumatic brain injury. Am J Public Health 2012; 102 (11) 2074-2079
    CrossrefPubMedGoogle Scholar
  • 19 Königs M, Heij HA, van Der Sluijs JA , et al. Pediatric traumatic brain injury and attention deficit. Pediatrics 2015; 136 (3) 534-541
    CrossrefPubMedGoogle Scholar
  • 20 Anderson V, Jacobs R, Spencer-Smith M , et al. Does early age at brain insult predict worse outcome? Neuropsychological implications. J Pediatr Psychol 2010; 35 (7) 716-727
    CrossrefPubMedGoogle Scholar
  • 21 Di Battista A, Soo C, Catroppa C, Anderson V. Quality of life in children and adolescents post-TBI: a systematic review and meta-analysis. J Neurotrauma 2012; 29 (9) 1717-1727
    CrossrefPubMedGoogle Scholar
  • 22 Durham SR, Clancy RR, Leuthardt E , et al. CHOP infant coma scale (“infant face scale”): a novel coma scale for children less than two years of age. J Neurotrauma 2000; 17 (9) 729-737
    CrossrefPubMedGoogle Scholar
  • 23 Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT ; Workshop Scientific Team and Advisory Panel Members. Classification of traumatic brain injury for targeted therapies. J Neurotrauma 2008; 25 (7) 719-738
    CrossrefPubMedGoogle Scholar
  • 24 Kuppermann N, Holmes JF, Dayan PS , et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374 (9696) 1160-1170
    CrossrefPubMedGoogle Scholar
  • 25 Mannix R, Bourgeois FT, Schutzman SA, Bernstein A, Lee LK. Neuroimaging for pediatric head trauma: do patient and hospital characteristics influence who gets imaged?. Acad Emerg Med 2010; 17 (7) 694-700
    CrossrefPubMedGoogle Scholar
  • 26 Schunk JE, Rodgerson JD, Woodward GA. The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. Pediatr Emerg Care 1996; 12 (3) 160-165
    CrossrefPubMedGoogle Scholar
  • 27 Palchak MJ, Holmes JF, Vance CW , et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 2003; 42 (4) 492-506
    CrossrefPubMedGoogle Scholar
  • 28 Miglioretti DL, Johnson E, Williams A , et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013; 167 (8) 700-707
    CrossrefPubMedGoogle Scholar
  • 29 Pearce MS, Salotti JA, Little MP , et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; 380 (9840) 499-505
    CrossrefPubMedGoogle Scholar
  • 30 Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child 2014; 99 (5) 427-431
    CrossrefPubMedGoogle Scholar
  • 31 Mihindu E, Bhullar I, Tepas J, Kerwin A. Computed tomography of the head in children with mild traumatic brain injury. Am Surg 2014; 80 (9) 841-843
    PubMedGoogle Scholar
  • 32 Atabaki SM, Hoyle Jr JD, Schunk JE , et al; Pediatric Emergency Care Applied Research Network (PECARN). Comparison of prediction rules and clinician suspicion for identifying children with clinically important brain injuries after blunt head trauma. Acad Emerg Med 2016;
    PubMedGoogle Scholar
  • 33 Lee LK, Monroe D, Bachman MC , et al; Traumatic Brain Injury (TBI) Working Group of Pediatric Emergency Care Applied Research Network (PECARN). Isolated loss of consciousness in children with minor blunt head trauma. JAMA Pediatr 2014; 168 (9) 837-843
    CrossrefPubMedGoogle Scholar
  • 34 Dayan PS, Holmes JF, Atabaki S , et al; Traumatic Brain Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med 2014; 63 (6) 657-665
    CrossrefPubMedGoogle Scholar
  • 35 Buttram SDW, Garcia-Filion P, Miller J , et al. Computed tomography vs magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hosp Pediatr 2015; 5 (2) 79-84
    PubMedGoogle Scholar
  • 36 Foerster BR, Petrou M, Lin D , et al. Neuroimaging evaluation of non-accidental head trauma with correlation to clinical outcomes: a review of 57 cases. J Pediatr 2009; 154 (4) 573-577
    CrossrefPubMedGoogle Scholar
  • 37 Kemp AM, Rajaram S, Mann M , et al; Welsh Child Protection Systematic Review Group. What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol 2009; 64 (5) 473-483
    CrossrefPubMedGoogle Scholar
  • 38 Amyot F, Arciniegas DB, Brazaitis MP , et al. A review of the effectiveness of neuroimaging modalities for the detection of traumatic brain injury. J Neurotrauma 2015; 32 (22) 1693-1721
    CrossrefPubMedGoogle Scholar
  • 39 Cohen AR, Caruso P, Duhaime A-C, Klig JE. Feasibility of “rapid” magnetic resonance imaging in pediatric acute head injury. Am J Emerg Med 2015; 33 (7) 887-890
    CrossrefPubMedGoogle Scholar
  • 40 Yuh EL, Mukherjee P, Lingsma HF , et al; TRACK-TBI Investigators. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol 2013; 73 (2) 224-235
    CrossrefPubMedGoogle Scholar
  • 41 Duhaime A-C, Rindler R. Special considerations in infants and children. In: Grafman J, Aminoff M, eds. Handbook of Clinical Neurology, Traumatic Brain Injury, Part I. Philadelphia: Elsevier; 2015: 219-242
    CrossrefGoogle Scholar