TY - JOUR
T1 - Acute Imaging Findings Predict Recovery of Cognitive and Motor Function after Inpatient Rehabilitation for Pediatric Traumatic Brain Injury
T2 - A Pediatric Brain Injury Consortium Study
AU - Caliendo, Eric T.
AU - Kim, Nayoung
AU - Edasery, David
AU - Askin, Gulce
AU - Nowak, Sophie
AU - Gerber, Linda M.
AU - Baum, Katherine T.
AU - Blackwell, Laura S.
AU - Koterba, Christine H.
AU - Hoskinson, Kristen R.
AU - Kurowski, Brad G.
AU - McLaughlin, Matthew
AU - Tlustos, Sarah J.
AU - Watson, William D.
AU - Niogi, Sumit N.
AU - Suskauer, Stacy J.
AU - Shah, Sudhin A.
N1 - Publisher Copyright:
© Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.
PY - 2021/7/15
Y1 - 2021/7/15
N2 - Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children; survivors experience long-term cognitive and motor deficits. To date, studies predicting outcome following pediatric TBI have primarily focused on acute behavioral responses and proxy measures of injury severity; unsurprisingly, these measures explain very little of the variance following heterogenous injury. In adults, certain acute imaging biomarkers help predict cognitive and motor recovery following moderate to severe TBI. This multi-center, retrospective study, characterizes the day-of-injury computed tomographic (CT) reports of pediatric, adolescent, and young adult patients (2 months to 21 years old) who received inpatient rehabilitation services for TBI (n = 247). The study also determines the prognostic utility of CT findings for cognitive and motor outcomes assessed by the Pediatric Functional Independence Measure, converted to age-appropriate developmental functional quotient (DFQ), at discharge from rehabilitation. Subdural hematomas (66%), contusions (63%), and subarachnoid hemorrhages (59%) were the most common lesions; the majority of subjects had less severe Rotterdam CT scores (88%, ≤ 3). After controlling for age, gender, mechanism of injury, length of acute hospital stay, and admission DFQ in multivariate regression analyses, the highest Rotterdam score (β =-25.2, p < 0.01) and complete cisternal effacement (β =-19.4, p < 0.05) were associated with lower motor DFQ, and intraventricular hemorrhage was associated with lower motor (β =-3.7, p < 0.05) and cognitive DFQ (β =-4.9, p < 0.05). These results suggest that direct detection of intracranial injury provides valuable information to aid in prediction of recovery after pediatric TBI, and needs to be accounted for in future studies of prognosis and intervention.
AB - Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children; survivors experience long-term cognitive and motor deficits. To date, studies predicting outcome following pediatric TBI have primarily focused on acute behavioral responses and proxy measures of injury severity; unsurprisingly, these measures explain very little of the variance following heterogenous injury. In adults, certain acute imaging biomarkers help predict cognitive and motor recovery following moderate to severe TBI. This multi-center, retrospective study, characterizes the day-of-injury computed tomographic (CT) reports of pediatric, adolescent, and young adult patients (2 months to 21 years old) who received inpatient rehabilitation services for TBI (n = 247). The study also determines the prognostic utility of CT findings for cognitive and motor outcomes assessed by the Pediatric Functional Independence Measure, converted to age-appropriate developmental functional quotient (DFQ), at discharge from rehabilitation. Subdural hematomas (66%), contusions (63%), and subarachnoid hemorrhages (59%) were the most common lesions; the majority of subjects had less severe Rotterdam CT scores (88%, ≤ 3). After controlling for age, gender, mechanism of injury, length of acute hospital stay, and admission DFQ in multivariate regression analyses, the highest Rotterdam score (β =-25.2, p < 0.01) and complete cisternal effacement (β =-19.4, p < 0.05) were associated with lower motor DFQ, and intraventricular hemorrhage was associated with lower motor (β =-3.7, p < 0.05) and cognitive DFQ (β =-4.9, p < 0.05). These results suggest that direct detection of intracranial injury provides valuable information to aid in prediction of recovery after pediatric TBI, and needs to be accounted for in future studies of prognosis and intervention.
KW - Rotterdam criteria
KW - WeeFIM
KW - computed tomography
KW - pediatric traumatic brain injury
KW - rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85106390511&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85106390511&partnerID=8YFLogxK
U2 - 10.1089/neu.2020.7437
DO - 10.1089/neu.2020.7437
M3 - Article
C2 - 33504256
AN - SCOPUS:85106390511
SN - 0897-7151
VL - 38
SP - 1961
EP - 1968
JO - Journal of neurotrauma
JF - Journal of neurotrauma
IS - 14
ER -