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Abstract

Optimal management of the severely injured child with neurotrauma includes specific challenges which reflect the unique epidemiologic, mechanistic, diagnostic, physiologic, neurodevelopmental, and social characteristics at each stage of maturation. This chapter will cover some of the patterns to recognize and some of the pitfalls to avoid in children of different ages and presentations. We will begin with an overview of specific characteristics and principles in each realm, and then review how these considerations influence management by exploring some typical pediatric polytrauma scenarios.

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References

  1. Faul M, Xu L, Wald M, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006, in U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Injury Prevention and Control. 2010. p. 1–74.

    Google Scholar 

  2. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH. A population-based study of inflicted traumatic brain injury in young children. JAMA. 2003;290:621–6.

    Article  PubMed  Google Scholar 

  3. Keenan HT, Bratton SL. Epidemiology and outcomes of pediatric traumatic brain injury. Dev Neurosci. 2006;28(4–5):256–63.

    Article  CAS  PubMed  Google Scholar 

  4. Johnston BD, Ebel BE. Child injury control: trends, themes, and controversies. Acad Pediatr. 2013;13(6):499–507.

    Article  PubMed  Google Scholar 

  5. Gilchrist J, Thomas KE, Xu L, McGuire LC, Coronado V. Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged ≤19 Years—United States, 2001–2009. In: Center for Disease Control and Prevention Morbidity and Mortality Weekly Report. 2011. p. 1337–42.

    Google Scholar 

  6. Helmkamp JC, Bixler DM, Kaplan J. All-Terrain Vehicle Fatalities-West Virginia. 2008;1999–2006:1–24.

    Google Scholar 

  7. Prevention, C.f.D.C.a. Injury Prevention and Control: Data and Statistics (WISQARS). 2010.

    Google Scholar 

  8. World Health Organization. Neurological Disorders: Public health challenges. 2010. p. 1–232.

    Google Scholar 

  9. Klimo TP, Ragel MB, Jones MG, McCafferty MR. Severe pediatric head injury during the Iraq and Afghanistan conflicts. Neurosurgery. 2015;77(1):1–7.

    Article  PubMed  Google Scholar 

  10. Saatman KE, Duhaime AC, Bullock MR, Maas AI, Valadka AB, Manley GT, et al. Classification of traumatic brain injury for targeted therapies. J Neurotrauma 2008;25:719–38.

    Google Scholar 

  11. Ewing-Cobbs L, Miner ME, Fletcher JM, Levin HS. Intellectual, motor, and language sequelae following closed head injury in infants and preschoolers. J Pediatr Psych. 1989;14(4):531–47.

    Article  CAS  Google Scholar 

  12. Ewing-Cobbs L, Barnes M, Fletcher JM, Levin HS, Swank PR, Song J. Modeling of longitudinal academic achievement scores after pediatric traumatic brain injury. Dev Neuropsychol. 2004;25(1–2):107–33.

    Article  PubMed  Google Scholar 

  13. Ewing-Cobbs L, Prasad MR, Landry SH, Kramer L, Deleon R. Executive functions following traumatic brain injury in young children: a preliminary analysis. Dev Neuropsychol. 2004;26(1):487–512.

    Article  PubMed  Google Scholar 

  14. Parsons S, Carter E, Waterhouse L, Fritzeen J, Kelleher DC, O’Connell K, Sarcevic A, Baker K, Nelson E, Werner N, Boehm-Davis D, Burd R. Improving ATLS performance in simulated pediatric trauma resuscitation using a checklist. Ann Surg. 2014;259(4):807–13.

    Article  PubMed  Google Scholar 

  15. Kochanek PM, ed. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. In: Kochanek PM, editor. Pediatric Critical Care Medicine, Vol. 31. 2003.

    Google Scholar 

  16. Durham S, Clancy RR, Leuthardt E, Sun P, Kamerling S, Dominguez T, Duhaime AC. The CHOP Infant Coma Scale (“Infant Face Scale”): a novel coma scale for children less than two years of age. J Neurotrauma. 2000;17(9):729–37.

    Article  CAS  PubMed  Google Scholar 

  17. Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR. 2001;176:289–96.

    Article  CAS  PubMed  Google Scholar 

  18. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84.

    Article  CAS  PubMed  Google Scholar 

  19. Hall P, Adami H, Trichopoulos D, Pedersen N, Lagiou P, Ekbom A, Ingvar M, Lundell M, Granath F. Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study. Br Med J. 2004;328:19 (3 Jan 2004).

    Google Scholar 

  20. Goske MJ, Applegate KE, Bell C, Boylan J, Bulas D, Butler P, Callahan MJ, Coley BD, Farley S, Frush DP, McElveny C, Hernanz-Schulman M, Johnson ND, Kaste SC, Morrison G, Strauss KJ. Image Gently: providing practical educational tools and advocacy to accelerate radiation protection for children worldwide. Semin Ultrasound CT MR. 2010;31(1):57–63.

    Article  PubMed  Google Scholar 

  21. Cohen AR, Caruso P, Duhaime A-C, Klig JE. Feasibility of “rapid” magnetic resonance imaging in pediatric acute head injury. Am J Emerg Med. 2015;33(7):887–90.

    Article  PubMed  Google Scholar 

  22. Duhaime AC, Gean AD, Haacke EM, Hicks R, Wintermark M, Mukherjee P, Brody D, Latour L, Riedy G. Common data elements in radiologic imaging of traumatic brain injury. Arch Phys Med Rehabil. 2010;91(11):1661–6.

    Article  PubMed  Google Scholar 

  23. Duhaime AC, Holshouser B, Hunter JV, Tong K. Common data elements for neuroimaging of traumatic brain injury: pediatric considerations. J Neurotrauma. 2012;29(4):629–33.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC. Cervical spine injury patterns in children. Pediatrics. 2014;133(5):e1179.

    Article  PubMed  Google Scholar 

  25. Bennett DT, Bratton LS, Riva-Cambrin RJ, Scaife LE, Nance SM, Prince TJ, Wilkes TJ, Keenan TH. Cervical spine imaging in hospitalized children with traumatic brain injury. Pediatr Emerg Care. 2015;31(4):243–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Henry M, Riesenburger R, Kryzanski J, Jea A, Hwang S. A retrospective comparison of CT and MRI in detecting pediatric cervical spine injury. Childs Nerv Syst. 2013;29(8):1333–8.

    Article  PubMed  Google Scholar 

  27. Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. (Report). Pediatr Radiol. 2014;44(7):839.

    Article  PubMed  Google Scholar 

  28. Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, Olney JW, Wozniak DF. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–82.

    CAS  PubMed  Google Scholar 

  29. Wang C, Slikker W. Strategies and experimental models for evaluating anesthetics: effects on the developing nervous system. Anesth Analg. 2008;106:1643–58.

    Article  CAS  PubMed  Google Scholar 

  30. Olsen EA, Brambrink AM. Anesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain. Curr Opin Anaesthesiol. 2013;26(6):677.

    Article  CAS  PubMed  Google Scholar 

  31. 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. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents–second edition. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2012;13(Suppl 1):S1.

    Google Scholar 

  32. Duhaime A-C, Rindler R. Special considerations in infants and children. In: J.a.S. Grafman AM editor. Handbook of Clinical Neurology, Traumatic Brain Injury, Part I. Elsevier: Philadelphia;2015. p. 219–42.

    Google Scholar 

  33. Missios S, Harris BT, Dodge CP, Simoni MK, Costine BA, Lee YL, Quebada PB, Hillier SC, Adams LB, Duhaime AC. Scaled cortical impact in immature swine: effect of age and gender on lesion volume. J Neurotrauma. 2009;26(11):1943–51.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Reid AB, Letts RM, Black GB. Pediatric chance fractures: association with intraabdominal injuries and seatbelt use. J Trauma. 1990;30(4):384–91.

    Article  CAS  PubMed  Google Scholar 

  35. Arkader CA, Warner TW, Tolo DV, Sponseller LP, Skaggs LD. Pediatric Chance Fractures: A Multicenter Perspective. J Pediat Orthop. 2011;31(7):741–4.

    Article  Google Scholar 

  36. Duhaime AC, Eppley M, Margulies S, Heher KL, Bartlett S. Crush injuries to the head in children. Neurosurgery. 1995;37:401–7.

    Article  CAS  PubMed  Google Scholar 

  37. Prasad MR, Ewing-Cobbs L, Baumgartner J. Crush head injuries in infants and young children: neurologic and neuropsychologic sequelae. J Child Neurology. 1999;14(8):496–501.

    Article  CAS  Google Scholar 

  38. Christian CW, Block R. Abusive head trauma in infants and children. Pediatrics. 2009;123(5):1409–11.

    Article  PubMed  Google Scholar 

  39. Rubin DM, Christian CW, Bilaniuk LT, Zazyczny, KA, Durbin DR. Occult head injury in high-risk abused children. Pediatrics. 2003; 111((6 Pt 1)): 1382–6.

    Google Scholar 

  40. Duhaime AC, Bilaniuk L, Zimmerman R. The “big black brain”: radiographic changes after severe inflicted head injury in infancy. J Neurotrauma. 1993;10(Suppl 1):S59.

    Google Scholar 

  41. Ewing-Cobbs L, Kramer L, Prasad M, Canales DN, Louis PT, Fletcher JM, Vollero H, Landry SH, Cheung K. Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children. Pediatrics. 1998;102(2 Pt 1):300–7.

    Article  CAS  PubMed  Google Scholar 

  42. Bennett S, Ward M, Moreau K, Fortin G, King J, MacKay M, Plint A. Head injury secondary to suspected child maltreatment: results of a prospective Canadian National Surveillance Program. Child Abuse Neglect: Int J. 2011;35(11):930–6.

    Article  Google Scholar 

  43. Keenan H, Runyan D, Marshall S, Nocera MA, Merten D. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics. 2004;114(3):633–9.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Vezina G. Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI. Pediatr Radiol. 2009;39(6):586–90.

    Article  PubMed  Google Scholar 

  45. Vazquez E, Delgado I, Sanchez-Montanez A, Fabrega A, Cano P, Martin N. Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging? Pediatr Radiol. 2014;44:589–603.

    Article  Google Scholar 

  46. Adamo MA, Drazin D, Waldman JB. Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries. J Neurosurg Pediatr. 2009;3(4):334.

    Article  PubMed  Google Scholar 

  47. Oluigbo CO, Wilkinson CC, Stence NV, Fenton LZ, McNatt SA, Handler MH. Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma. J Neurosurg Pediatr. 2012;9(2):125.

    Article  PubMed  Google Scholar 

  48. Duhaime AC, Christian C, Moss E, Seidl T. Long-term outcome in children with the shaking-impact syndrome. Pediatr Neurosurg. 1996;24:292–8.

    Article  CAS  PubMed  Google Scholar 

  49. Nakawara TA, Ashwal S, Mathur M, Mysore M. Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendation—executive summary. Ann Neurol. 2012;71(4):573–88.

    Article  Google Scholar 

  50. Levin HS, Hanten G, Roberson G, Li X, Ewing-Cobbs L, Dennis M, Chapman S, Max JE, Hunter J, Schachar R, Luerssen TG, Swank P. Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury. J Neurosurg Pediatr. 2008;461–70.

    Google Scholar 

  51. McCauley SR, Wilde EA, Anderson VA, Bedell G, Beers SR, Campbell TF, Chapman SB, Ewing-Cobbs L, Gerring JP, Gioia GA, Levin HS, Michaud LJ, Prasad MR, Swaine BR, Turkstra LS, Wade SL, Yeates KO. Recommendations for the Use of Common Outcome Measures in Pediatric Traumatic Brain Injury Research. J Neurotrauma. 2012;678–705.

    Google Scholar 

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Correspondence to Ann-Christine Duhaime .

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Duhaime, AC. (2017). Pediatric Neurotrauma. In: Ecklund, J., Moores, L. (eds) Neurotrauma Management for the Severely Injured Polytrauma Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-40208-6_29

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  • DOI: https://doi.org/10.1007/978-3-319-40208-6_29

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