Journal of neurotrauma
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Journal of neurotrauma · Jan 2007
Neurointensive care; impaired cerebral autoregulation in infants and young children early after inflicted traumatic brain injury: a preliminary report.
The objective of this report is to describe cerebral autoregulation after severe inflicted pediatric traumatic brain injury (iTBI). We examined cerebral autoregulation of both cerebral hemispheres (mean autoregulatory index; ARI) in children <5 years with Glasgow Coma Scale (GCS) score of <9 and no evidence of brain death within the first 48 h of pediatric intensive care unit (PICU) admission. Discharge and 6-month Glasgow Outcome Scale (GOS) scores were collected. ⋯ Two of the children with nTBI had intact autoregulation in both hemispheres and good outcome. Two of the three children with iTBI had differential effects on autoregulation between hemispheres despite bilateral injury. These are, to our knowledge, the first data on cerebral blood flow autoregulation in the unique setting of iTBI and provide a rationale for further study of their relationship to outcome and effects of therapy.
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Journal of neurotrauma · Jan 2007
Hypoxic-ischemic injury complicates inflicted and accidental traumatic brain injury in young children: the role of diffusion-weighted imaging.
We evaluated the relationship between clinical features and hypoxic-ischemic injury (HII) shown by diffusion-weighted MRI (DWI) in young children with head trauma, comparing inflicted trauma (IT) to accidental trauma (AT). This single-center consecutive cohort study included children age birth to 36 months admitted for head injury July 2001 to December 2004 with brain magnetic resonance imaging (MRI) obtained < or =1 week, identified from prospectively maintained registries of children with trauma. Clinical and radiological data during the hospital stay were extracted from medical records. ⋯ Our study is the first to characterize HII using diffusion-weighted MRI in young children, comparing IT and AT. The higher rate of HII on DWI-MRI in IT than in AT is likely multifactorial, involving respiratory insufficiency, seizures, and intracranial mass-occupying lesions requiring neurosurgical intervention. HII predicted need for in-patient rehabilitation in a large majority of children.
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Journal of neurotrauma · Jan 2007
Effects of crystalloid-colloid solutions on traumatic brain injury.
The purpose of this study was to compare the effects of crystalloid and crystalloid-colloid solutions administered at different times after isolated traumatic brain injury. Male Sprague-Dawley rats were randomized to receive one of three intravenous treatments (4 mL/kg body weight) at 10 min or 6 h after moderate traumatic brain injury. Treatments included hypertonic saline, hypertonic albumin, and normal albumin. ⋯ The presence of colloid in the infusion solutions was associated with an improvement in tissue damage and edema following isolated head injury while hypertonic saline alone, when given immediately after injury, worsened tissue damage and edema. When hypertonic saline was administered at 6 h after injury, tissue damage and edema were not worsened. In conclusion, the presence of colloid in solutions used to treat traumatic brain injury and the timing of treatment have a significant impact on tissue damage and edema.
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Journal of neurotrauma · Jan 2007
Hybrid outcome prediction model for severe traumatic brain injury.
Numerous studies addressing different methods of head injury prognostication have been published. Unfortunately, these studies often incorporate different head injury prognostication models and study populations, thus making direct comparison difficult, if not impossible. Furthermore, newer artificial intelligence tools such as machine learning methods have evolved in the field of data analysis, alongside more traditional methods of analysis. ⋯ Consistently high outcome prediction accuracy was seen with logistic regression and decision tree. Combining both logistic regression and decision tree models, a hybrid prediction model was then developed. This hybrid model would more accurately predict the 6-month post-severe head injury outcome using baseline admission parameters.