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Pediatric traumatic brain injury

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https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#1
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28814246/approach-to-pediatric-traumatic-brain-injury-in-the-emergency-department
#2
Gurinder Sangha
Traumatic Brain Injury is a major cause of morbidity and mortality in the pediatric population affecting millions of people yearly. It is important that practitioners have the knowledge and skills to care for these complicated patients, as the initial care can significantly affect the course of the injury. We discuss the initial management of traumatic brain injury based on mild, moderate and severe presentations. Management strategies to address Intracranial Pressure and Cerebral perfusion pressure, the use of oxygenation and ventilation strategies, temperature, correction of metabolic abnormalities and seizure care are discussed...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28808845/targeted-treatment-in-severe-traumatic-brain-injury-in-the-age-of-precision-medicine
#3
Anthony A Figaji, A Graham Fieggen, Ncedile Mankahla, Nico Enslin, Ursula K Rohlwink
In recent years, much progress has been made in our understanding of traumatic brain injury (TBI). Clinical outcomes have progressively improved, but evidence-based guidelines for how we manage patients remain surprisingly weak. The problem is that the many interventions and strategies that have been investigated in randomized controlled trials have all disappointed. These include many concepts that had become standard care in TBI. And that is just for adult TBI; in children, the situation is even worse. Not only is pediatric care more difficult than adult care because physiological norms change with age, but also there is less evidence for clinical practice...
August 14, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28790797/corrigendum-to-pediatric-traumatic-brain-injury-and-autism-elucidating-shared-mechanisms
#4
Rahul Singh, Ryan C Turner, Linda Nguyen, Kartik Motwani, Michelle Swatek, Brandon P Lucke-Wold, Rabia Qaiser
[This corrects the article DOI: 10.1155/2016/8781725.].
2017: Behavioural Neurology
https://www.readbyqxmd.com/read/28774508/compliance-with-evidence-based-guidelines-for-computed-tomography-of-children-with-head-and-abdominal-trauma
#5
Ihab Halaweish, Jane Riebe-Rodgers, Amy Randall, Peter F Ehrlich
INTRODUCTION: Recently, two large prospective clinical trials developed and validated prediction rules for children at very low risk for clinically important traumatic brain injuries (ciTBI) or abdominal injury for whom CT is unnecessary. Specific criteria/guidelines were identified which if met would obviate the need for CT scanning. The purpose of this study was to assess compliance at a level one pediatric center with these guidelines as a tool for quality improvement. METHODS: Records of children admitted to our pediatric trauma center one year before and two years after publication of head (Kuppermann '09) and abdominal trauma (Holmes '13) CT imaging guidelines were reviewed...
July 14, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28762893/overlapping-microrna-expression-in-saliva-and-cerebrospinal-fluid-accurately-identifies-pediatric-traumatic-brain-injury
#6
Steven Daniel Hicks, Jeremiah Johnson, Molly C Carney, Harry Bramley, Robert P Olympia, Andrea C Loeffert, Neal J Thomas
Objectives To assess the accuracy and physiologic relevance of circulating microRNA (miRNA) as a biomarker of pediatric concussion, we compared changes in salivary miRNA and cerebrospinal fluid (CSF) miRNA following childhood traumatic brain injury (TBI). Study Design A case-cohort design was used to compare longitudinal miRNA concentrations in CSF of seven children with severe TBI against three controls without TBI. The miRNAs "altered" in CSF were interrogated in saliva of 60 children with mild TBI and compared with 18 age- and gender- matched controls...
August 1, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28762891/coping-strategies-used-by-parents-of-children-with-traumatic-brain-injury-a-cross-sectional-study-of-palestinians-and-israelis
#7
Wedad Masalha, Gail Auslander
This study examined the use and helpfulness of coping strategies and patterns among parents of children with traumatic brain injury (TBI). Participants were 122 Arab-Israeli, Jewish-Israeli, and Palestinian parents of 65 children with TBI following their discharge from pediatric rehabilitation hospital. Family-focused strategies were highly prevalent and most helpful among both mothers and fathers. Jewish mothers reported that support coping pattern (but not medical or family) was more helpful than did Arab-Israeli and Palestinian mothers...
August 1, 2017: Social Work in Health Care
https://www.readbyqxmd.com/read/28745856/severe-traumatic-brain-injury-in-children-an-evidence-based-review-of-emergency-department-management-digest
#8
Kirsten Morrissey, Hilary Fairbrother, Michelle N Vazquez
More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged < 14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. Early identification and management of severe traumatic brain injury is crucial in decreasing the risk of secondary brain injury and optimizing outcome. The main focus for early management of severe traumatic brain injury is to mitigate and prevent secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes...
October 22, 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28744846/extubation-failure-and-tracheostomy-placement-in-children-with-acute-neurocritical-illness
#9
Ellen C Cohn, Tammy S Robertson, Stacey A Scott, Andre M Finley, Rong Huang, Darryl K Miles
BACKGROUND: There is a lack of data describing the risk factors for extubation failure (EF) or tracheostomy placement in pediatric neurocritical care (NCC) patients. METHODS: A retrospective chart review of children admitted to the pediatric intensive care unit who were intubated for >24 h with an acute neurocritical illness and had an extubation attempt. Bivariate and multivariate statistical analysis was performed to determine significant associations of demographic, neurologic, pulmonary, and clinical variables with EF and tracheostomy placement...
July 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28731871/online-family-problem-solving-for-pediatric-traumatic-brain-injury-influences-of-parental-marital-status-and-participation-on-adolescent-outcomes
#10
Stacey P Raj, Nanhua Zhang, Michael W Kirkwood, H Gerry Taylor, Terry Stancin, Tanya M Brown, Shari L Wade
OBJECTIVE: To examine the moderating effects of parent marital status and participation on efficacy of an online family problem-solving intervention for pediatric traumatic brain injury (TBI). METHODS: Participants were 132 adolescents (12-17 years) who had sustained a recent (<6 months) TBI and their parents. Participants were randomly assigned to the intervention (Counselor-Assisted Problem Solving, CAPS) or an Internet resource comparison (IRC) condition. CAPS was designed to support families in the initial phase following TBI, by teaching problem-solving skills and addressing common challenges...
July 20, 2017: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/28724747/interleukin-1-receptor-in-seizure-susceptibility-after-traumatic-injury-to-the-pediatric-brain
#11
Bridgette D Semple, Terence J O'Brien, Kayleen Gimlin, David K Wright, Shi Eun Kim, Pablo M Casillas-Espinosa, Kyria M Webster, Steven Petrou, Linda J Noble-Haeusslein
Epilepsy after pediatric traumatic brain injury (TBI) is associated with poor quality of life. This study aimed to characterize post-traumatic epilepsy in a mouse model of pediatric brain injury, and to evaluate the role of interleukin-1 (IL-1) signaling as a target for pharmacological intervention. Male mice received a controlled cortical impact or sham surgery at postnatal day 21, approximating a toddler-aged child. Mice were treated acutely with an IL-1 receptor antagonist (IL-1Ra; 100 mg/kg s.c.) or vehicle...
July 19, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28721596/central-adrenal-insufficiency-following-traumatic-brain-injury-a-missed-diagnosis-in-the-critically-injured
#12
Eileen Fan, Peter W Skippen, Michael A Sargent, David D Cochrane, Jean-Pierre Chanoine
BACKGROUND: High-dose steroid administration is no longer recommended in the treatment of acute traumatic brain injury (TBI) as it failed to prove beneficial in improving patients' outcome. However, a masked benefit of steroid administration in TBI management was that it provided corticosteroid replacement therapy in patients with TBI-related central adrenal insufficiency. CASE PRESENTATION: We report the case of a 12-year-old boy who suffered a severe TBI from a motor vehicle accident that resulted in complete deficiency of anterior pituitary function...
July 18, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28712906/a-comparison-of-pharmacologic-therapeutic-agents-used-for-the-reduction-of-intracranial-pressure-following-traumatic-brain-injury
#13
REVIEW
Ahmed M Alnemari, Brianna M Krafcik, Tarek R Mansour, Daniel Gaudin
OBJECTIVE: In neurotrauma care, a better understanding of treatments following traumatic brain injury (TBI) has led to a significant decrease in morbidity and mortality in this population. TBI represents a significant medical problem, and complications following TBI are associated with the initial injury and post-event intracranial processes such as elevated intracranial pressure (ICP) and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion...
July 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28710227/advancing-concussion-assessment-in-pediatrics-a-cap-a-prospective-concurrent-cohort-longitudinal-study-of-mild-traumatic-brain-injury-in-children-protocol-study
#14
Keith Owen Yeates, Miriam Beauchamp, William Craig, Quynh Doan, Roger Zemek, Bruce Bjornson, Jocelyn Gravel, Angelo Mikrogianakis, Bradley Goodyear, Nishard Abdeen, Christian Beaulieu, Mathieu Dehaes, Sylvain Deschenes, Ashley Harris, Catherine Lebel, Ryan Lamont, Tyler Williamson, Karen Maria Barlow, Francois Bernier, Brian L Brooks, Carolyn Emery, Stephen B Freedman, Kristina Kowalski, Kelly Mrklas, Lianne Tomfohr-Madsen, Kathryn J Schneider
INTRODUCTION: Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28700540/clinical-and-radiological-presentations-and-management-of-blunt-splenic-trauma-a-single-tertiary-hospital-experience
#15
Gaby Jabbour, Ammar Al-Hassani, Ayman El-Menyar, Husham Abdelrahman, Ruben Peralta, Mohammed Ellabib, Hisham Al-Jogol, Mohammed Asim, Hassan Al-Thani
BACKGROUND Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. MATERIAL AND METHODS A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. RESULTS A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13...
July 12, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28699371/minocycline-attenuates-high-mobility-group-box-1-translocation-microglial-activation-and-thalamic-neurodegeneration-after-traumatic-brain-injury-in-postnatal-day-17-rats
#16
Dennis William Simon, Rajesh K Aneja, Henry Alexander, Michael J Bell, Hulya Bayir, Patrick M Kochanek, Robert S B Clark
In response to cell injury the danger signal high mobility group box-1 (HMGB) is released, activating macrophages by binding pattern recognition receptors. We investigated the role of the anti-inflammatory drug minocycline in attenuating HMGB1 translocation, microglial activation, and neuronal injury in a rat model of pediatric traumatic brain injury (TBI). Postnatal day 17 Sprague-Dawley rats were subjected to moderate-severe controlled cortical impact (CCI). Animals were randomized to treatment with minocycline (90 mg/kg, i...
July 12, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28692623/a-retrospective-cohort-study-of-traumatic-brain-injury-and-usage-of-protective-headgear-during-equestrian-activities
#17
Donna S Lemoine, Bradley J Tate, Jennifer A Lacombe, Theresa C Hood
Some of the more popular sporting activities for those living in rural areas include equestrian activities such as rodeo events and horseback riding. The lack of helmet use poses a concern for those who participate in these activities due to the risk of sustaining a traumatic brain injury (TBI) and ultimately having a negative effect on their future. A retrospective cohort study was conducted at a trauma center comparing the data on animal-riding patients and their use or lack of use of headgear and incidence of TBI...
July 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28692408/preliminary-findings-of-altered-functional-connectivity-of-the-default-mode-network-linked-to-functional-outcomes-one-year-after-pediatric-traumatic-brain-injury
#18
Jaclyn A Stephens, Cynthia F Salorio, Anita D Barber, Sarah R Risen, Stewart H Mostofsky, Stacy J Suskauer
PURPOSE AND METHOD: This study examined functional connectivity of the default mode network (DMN) and examined brain-behavior relationships in a pilot cohort of children with chronic mild to moderate traumatic brain injury (TBI). RESULTS: Compared to uninjured peers, children with TBI demonstrated less anti-correlated functional connectivity between DMN and right Brodmann Area 40 (BA 40). In children with TBI, more anomalous less anti-correlated) connectivity between DMN and right BA 40 was linked to poorer performance on response inhibition tasks...
July 10, 2017: Developmental Neurorehabilitation
https://www.readbyqxmd.com/read/28688998/targeted-temperature-management-in-the-icu-guidelines-from-a-french-expert-panel
#19
Alain Cariou, Jean-Francois Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method...
July 5, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28686657/phase-i-randomized-clinical-trial-of-n-acetylcysteine-in-combination-with-an-adjuvant-probenecid-for-treatment-of-severe-traumatic-brain-injury-in-children
#20
Robert S B Clark, Philip E Empey, Hülya Bayır, Bedda L Rosario, Samuel M Poloyac, Patrick M Kochanek, Thomas D Nolin, Alicia K Au, Christopher M Horvat, Stephen R Wisniewski, Michael J Bell
BACKGROUND: There are no therapies shown to improve outcome after severe traumatic brain injury (TBI) in humans, a leading cause of morbidity and mortality. We sought to verify brain exposure of the systemically administered antioxidant N-acetylcysteine (NAC) and the synergistic adjuvant probenecid, and identify adverse effects of this drug combination after severe TBI in children. METHODS: IRB-approved, randomized, double-blind, placebo controlled Phase I study in children 2 to 18 years-of-age admitted to a Pediatric Intensive Care Unit after severe TBI (Glasgow Coma Scale [GCS] score ≤8) requiring an externalized ventricular drain for measurement of intracranial pressure (ICP)...
2017: PloS One
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