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Transcranial Doppler ultrasound findings in children with moderate-to-severe traumatic brain injury following abusive head trauma

  • Marlina E. LovettEmail author
  • Tensing Maa
  • Melissa Moore-Clingenpeel
  • Nicole F. O’Brien
Original Article
  • 24 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Transcranial Doppler ultrasound Traumatic brain injury Abusive head trauma 

Notes

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Critical Care MedicineNationwide Children’s HospitalColumbusUSA
  2. 2.Department of PediatricsThe Ohio State UniversityColumbusUSA
  3. 3.Biostatistics CoreResearch Institute at Nationwide Children’s HospitalColumbusUSA

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