TY - CHAP
T1 - Computed tomography indicators of deranged intracranial physiology in paediatric traumatic brain injury
AU - Young, Adam M.H.
AU - Donnelly, Joseph
AU - Liu, Xiuyun
AU - Guilfoyle, Mathew R.
AU - Carew, Melvin
AU - Cabeleira, Manuel
AU - Cardim, Danilo
AU - Garnett, Matthew R.
AU - Fernandes, Helen M.
AU - Haubrich, Christina
AU - Smielewski, Peter
AU - Czosnyka, Marek
AU - Hutchinson, Peter J.
AU - Agrawal, Shruti
N1 - Publisher Copyright:
© Springer International Publishing AG 2018.
PY - 2018
Y1 - 2018
N2 - Objective: Computed tomography (CT) of the brain can allow rapid assessment of intracranial pathology after traumatic brain injury (TBI). Frequently in paediatric TBI, CT imaging can fail to display the classical features of severe brain injury with raised intracranial pressure. The objective of this study was to determine early CT brain features that influence intracranial or systemic physiological trends following paediatric TBI. Materials and methods: Thirty-three patients (mean age, 10 years; range, 0.5–16) admitted between 2002 and 2015 were used for the current analysis. Presence of petechial haemorrhages, basal cistern compression, subarachnoid blood, midline shift and extra-axial masses on the initial trauma CT head were assessed. ICP and arterial blood pressure (ABP) were then monitored continuously with an intraparenchymal microtransducer and an indwelling arterial line. Pressure monitors were connected to bedside computers running ICM+ software. Pressure reactivity was determined as the moving correlation between 30, 10-s averages of ABP and ICP (PRx). The mean ICP, ABP, cerebral perfusion pressure (CPP; ABP minus ICP) and PRx were calculated for the whole monitoring period for each patient. Results: The presence of subarachnoid blood was related to higher ICP, higher ABP and a trend toward higher PRx. Smaller basal cisterns were related to increased ICP (R = −0.42, p = 0.02), impaired PRx (R = −0.5, p = 0.003). The presence of an extra-axial mass was associated with deranged PRx (−0.02 vs. 0.41, p = 0.003) and a trend toward higher ICP (14 vs. 40, p = 0.07). Interestingly the degree of midline shift was not related to ICP or PRx. Conclusions: The size of the basal cisterns, the presence of subarachnoid blood or an extra-axial mass are all related to disturbed ICP and pressure reactivity in this paediatric TBI cohort. Patients with these features are ideal candidates for invasive multimodal monitoring.
AB - Objective: Computed tomography (CT) of the brain can allow rapid assessment of intracranial pathology after traumatic brain injury (TBI). Frequently in paediatric TBI, CT imaging can fail to display the classical features of severe brain injury with raised intracranial pressure. The objective of this study was to determine early CT brain features that influence intracranial or systemic physiological trends following paediatric TBI. Materials and methods: Thirty-three patients (mean age, 10 years; range, 0.5–16) admitted between 2002 and 2015 were used for the current analysis. Presence of petechial haemorrhages, basal cistern compression, subarachnoid blood, midline shift and extra-axial masses on the initial trauma CT head were assessed. ICP and arterial blood pressure (ABP) were then monitored continuously with an intraparenchymal microtransducer and an indwelling arterial line. Pressure monitors were connected to bedside computers running ICM+ software. Pressure reactivity was determined as the moving correlation between 30, 10-s averages of ABP and ICP (PRx). The mean ICP, ABP, cerebral perfusion pressure (CPP; ABP minus ICP) and PRx were calculated for the whole monitoring period for each patient. Results: The presence of subarachnoid blood was related to higher ICP, higher ABP and a trend toward higher PRx. Smaller basal cisterns were related to increased ICP (R = −0.42, p = 0.02), impaired PRx (R = −0.5, p = 0.003). The presence of an extra-axial mass was associated with deranged PRx (−0.02 vs. 0.41, p = 0.003) and a trend toward higher ICP (14 vs. 40, p = 0.07). Interestingly the degree of midline shift was not related to ICP or PRx. Conclusions: The size of the basal cisterns, the presence of subarachnoid blood or an extra-axial mass are all related to disturbed ICP and pressure reactivity in this paediatric TBI cohort. Patients with these features are ideal candidates for invasive multimodal monitoring.
KW - Brain
KW - Imaging
KW - Injury
KW - Pediatric
KW - Trauma
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U2 - 10.1007/978-3-319-65798-1_7
DO - 10.1007/978-3-319-65798-1_7
M3 - Chapter
C2 - 29492527
AN - SCOPUS:85042939101
T3 - Acta Neurochirurgica, Supplementum
SP - 29
EP - 34
BT - Acta Neurochirurgica, Supplementum
PB - Springer-Verlag Wien
ER -