Research Reports - Low brain oxygenation and differences in neuropsychological outcomes following severe pediatric TBI

Childs Nerv Syst. 2015 Sep 4. [Epub ahead of print]

Schrieff-Elson LE(1), Thomas KG, Rohlwink UK, Figaji AA.

PURPOSE: Traumatic brain injury (TBI) is a leading cause of morbidity and
mortality in children. Preventing secondary injury by controlling physiological
parameters (e.g. intracranial pressure [ICP], cerebral perfusion pressure [CPP]
and brain tissue oxygen [PbtO2]) has a potential to improve outcome. Low PbtO2 is
independently associated with poor clinical outcomes in both adults and children.
However, no studies have investigated associations between low PbtO2 and
neuropsychological and behavioural outcomes following severe pediatric TBI
(pTBI).
METHODS: We used a quasi-experimental case-control design to investigate these
relationships. A sample of 11 TBI patients with a Glasgow Coma Scale score ≤8 who
had PbtO2 and ICP monitoring at the Red Cross War Memorial Children's Hospital
underwent neuropsychological evaluation ≥1 year post-injury. Their performance
was compared to that of 11 demographically matched healthy controls. We then
assigned each TBI participant into one of two subgroups, (1) children who had
experienced at least one episode of PbtO2 ≤ 10 mmHg or (2) children for whom
PbtO2 > 10 mmHg throughout the monitoring period, and compared their results on
neuropsychological evaluation.
RESULTS: TBI participants performed significantly more poorly than controls in
several cognitive domains (IQ, attention, visual memory, executive functions and
expressive language) and behavioural (e.g. externalizing behaviour) domains. The
PbtO2 ≤ 10 mmHg group performed significantly worse than the PbtO2 > 10 mmHg
group in several cognitive domains (IQ, attention, verbal memory, executive
functions and expressive language), but not on behavioural measures.
CONCLUSION: Results demonstrate that low PbtO2 may be prognostic of not only
mortality but also neuropsychological outcomes. 

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