Research Reports - Computed tomography characteristics in pediatric versus adult traumatic brain injury

J Neurosurg Pediatr. 2014 Jan 10

Sarkar K, Keachie K, Nguyen U, Muizelaar JP, Zwienenberg-Lee M, Shahlaie K

Object Traumatic brain injury (TBI) is a leading cause of injury,
hospitalization, and death among pediatric patients. Admission CT scans play an
important role in classifying TBI and directing clinical care, but little is
known about the differences in CT findings between pediatric and adult patients.
The aim of this study was to determine if radiographic differences exist between
adult and pediatric TBI. Methods The authors retrospectively analyzed TBI
registry data from 1206 consecutive patients with nonpenetrating TBI treated at a
Level 1 adult and pediatric trauma center over a 30-month period. Results The
distribution of sex, race, and Glasgow Coma Scale (GCS) score was not
significantly different between the adult and pediatric populations; however, the
distribution of CT findings was significantly different. Pediatric patients with
TBI were more likely to have skull fractures (OR 3.21, p < 0.01) and epidural
hematomas (OR 1.96, p < 0.01). Pediatric TBI was less likely to be associated
with contusion, subdural hematoma, subarachnoid hemorrhage, or compression of the
basal cisterns (p < 0.05). Rotterdam CT scores were significantly lower in the
pediatric population (2.3 vs 2.6, p < 0.001). Conclusions There are significant
differences in the CT findings in pediatric versus adult TBI, despite statistical
similarities with regard to clinical severity of injury as measured by the GCS.
These differences may be due to anatomical characteristics, the biomechanics of
injury, and/or differences in injury mechanisms between pediatric and adult
patients. The unique characteristics of pediatric TBI warrant consideration when
formulating a clinical trial design or predicting functional outcome using
prognostic models developed from adult TBI data.

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