Transcranial Doppler ultrasound findings in children with moderate-to-severe traumatic brain injury following abusive head trauma
- 24 Downloads
Abusive head trauma (AHT) is the leading cause of fatal head injuries for children under 2 years. The objective was to evaluate, using transcranial Doppler ultrasound (TCD), whether children with AHT have a similar neurovascular response to injury compared with children without AHT.
Retrospective sub-analysis of previously prospectively acquired data in a pediatric intensive care unit in a level 1 trauma hospital. TCD was performed daily until hospital day 8, discharge, or death. Neurologic outcome was assessed using the Glasgow Outcome Scale Extended (GOS-E Peds) at 1 month from initial injury.
Sixty-nine children aged 1 day to 17 years with moderate-to-severe traumatic brain injury were enrolled. Fifteen children suffered AHT and 54 had no suspicion for AHT. Fifteen children with AHT underwent 80 serial TCD examinations; 54 children without AHT underwent 308 exams. After standardization for age and gender normative values, there was no statistically significant difference in mean cerebral blood flow velocity of the middle cerebral artery (VMCA) between children with and without AHT. There was no difference in the incidence of extreme cerebral blood flow velocity (CBFV, greater or less than 2 standard deviations from normative value) between groups. Within the AHT group, there were no statistically significant differences in VMCA between children with a favorable (GOS-E Peds 1–4) versus unfavorable neurologic outcome (GOS-E Peds 5–8).
Children with AHT have no significant differences in VMCA or percentage of extreme CBFV in the middle cerebral artery compared to with those without AHT.
KeywordsTranscranial Doppler ultrasound Traumatic brain injury Abusive head trauma
Compliance with ethical standards
The parent study was approved by the institutional review board and informed consent was obtained prior to patient enrollment.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 5.Buckley EM, Miller BF, Golinski JM, Sadeghian H, McAllister LM, Vangel M, Ayata C, Meehan WP 3rd, Franceschini MA, Whalen MJ (2015) Decreased microvascular cerebral blood flow assessed by diffuse correlation spectroscopy after repetitive concussions in mice. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism 35:1995–2000. https://doi.org/10.1038/jcbfm.2015.161 CrossRefGoogle Scholar
- 6.Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, Moreno JA, Dias MS, Christian CW, Nelson MD Jr, Silvera VM, Palasis S, Raissaki M, Rossi A, Offiah AC (2018) Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48:1048–1065. https://doi.org/10.1007/s00247-018-4149-1 CrossRefPubMedGoogle Scholar
- 10.Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS, Warden CR, American Academy of Pediatrics-Section on Neurological S, American Association of Neurological Surgeons/Congress of Neurological S, Child Neurology S, European Society of P, Neonatal Intensive C, Neurocritical Care S, Pediatric Neurocritical Care Research G, Society of Critical Care M, Paediatric Intensive Care Society UK, Society for Neuroscience in A, Critical C, World Federation of Pediatric I, Critical Care S (2012) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents—second edition. Pediatr Crit Care Med 13(Suppl 1):S1–S82. https://doi.org/10.1097/PCC.0b013e31823f435c CrossRefPubMedGoogle Scholar
- 13.Lovett ME, Maa T, Chung MG, O'Brien NF (2018) Cerebral blood flow velocity and autoregulation in paediatric patients following a global hypoxic-ischaemic insult. Resuscitation 126:191–196. https://doi.org/10.1016/j.resuscitation.2018.02.005 CrossRefPubMedGoogle Scholar
- 14.Miller Ferguson N, Sarnaik A, Miles D, Shafi N, Peters MJ, Truemper E, Vavilala MS, Bell MJ, Wisniewski SR, Luther JF, Hartman AL, Kochanek PM, Investigators of the A, Decisions in Acute Pediatric Traumatic Brain Injury T (2017) Abusive head trauma and mortality-an analysis from an international comparative effectiveness study of children with severe traumatic brain injury. Crit Care Med 45:1398–1407. https://doi.org/10.1097/CCM.0000000000002378 CrossRefGoogle Scholar
- 18.Orru E, Huisman T, Izbudak I (2018) Prevalence, patterns, and clinical relevance of hypoxic-ischemic injuries in children exposed to abusive head trauma. Journal of neuroimaging : official journal of the American Society of Neuroimaging 28:608–614. https://doi.org/10.1111/jon.12555 CrossRefGoogle Scholar
- 19.Parks S, Annest J, Hill H, Karch D (2012) Pediatric abusive head trauma: recommended definitions for public health surveillance and research. Centers for Disease Control and PreventionGoogle Scholar
- 22.Thibeault CM, Thorpe S, O'Brien MJ, Canac N, Ranjbaran M, Patanam I, Sarraf A, LeVangie J, Scalzo F, Wilk SJ, Diaz-Arrastia R, Hamilton RB (2018) A cross-sectional study on cerebral hemodynamics after mild traumatic brain injury in a pediatric population. Front Neurol 9:200. https://doi.org/10.3389/fneur.2018.00200 CrossRefPubMedPubMedCentralGoogle Scholar