Traumatic Brain Injury: Comparison of Computed Tomography Findings in Pediatric and Adult Populations

Abstract

Introduction Traumatic brain injury (TBI) is a global health issue, accounting for a significant number of adult and pediatric deaths and morbidity. Computed tomography (CT) is an important diagnostic modality for TBI. The primary goal of this study was to determine if there were any significant radiological differences in CT brain findings between adult and pediatric populations.

Materials and Methods Data of individual patients were collected from admission to discharge/death, which included various parameters in terms of demographics, mechanism of injury, and patient outcome which were later analyzed. A total of 1,150 TBI patients were enrolled in the study.

Results The most common mode of injury in adults is road traffic accident (RTA) followed by fall from height (FFH), while in pediatrics it is vice versa. Findings of basal cisterns on CT brain were found to be statistically significant in both groups; 65% adults and 71% pediatrics had only one abnormal CT finding. Most common combination CT finding in adults was acute subdural hematoma (ASDH) and basal cistern abnormality, while in pediatrics it was traumatic subarachnoid hemorrhage (SAH) and contusion. Rotterdam score (based on CT brain findings) was significantly lower for pediatric age group compared with adults. It was 2.2 ± 0.85 for adults and 1.99 ± 0.74 for pediatrics, which was statistically significant (p < 0.001).

Conclusions The Rotterdam score has immense predictive power for prognostication of mortality status. Pediatric age group has better prognosis in terms of survival as compared with adults, thus justifying the role of Rotterdam CT score for mortality risk stratification in providing clinical care.

Keywords

traumatic brain injury - Rotterdam score - computed tomography scan

Publication History

Article published online:
28 April 2020

• References

• 1 NIH. Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH consensus development panel on rehabilitation of persons with traumatic brain injury. JAMA 1999; 282: 974-983
• 2 Langlois JA, Marr A, Mitchko J, Johnson RL. Tracking the silent epidemic and educating the public: CDC’s traumatic brain injury-associated activities under the TBI Act of 1996 and the Children’s Health Act of 2000. J Head Trauma Rehabil 2005; 20 (03) 196-204
• 3 WHO. World Report on Road Traffic Injury Prevention. Geneva: World Health Organization 2004
• 4 Tabish SA, Nabil S. Traumatic brain injury: the neglected epidemic of modern society. International Journal of Science and Research (IJSR) 2014; 3 (12) 382-406
• 5 Central department for Statistics and information. Annual statistical books (2009, 31 July). Available at: http://www.cdsi.gov.sa. Accessed November 2019
• 6 UNICEF: Statistics and monitoring. (2009, 30 July);Available at:http://www.unicef.org/statistics/index_step1.php. Accessed February, 6, 2020
• 7 Kapp C. Who acts on road safety to reverse accident trends-traffic accidents kill 1.26 million people each year, 2nd leading cause of death among those aged 15–29. Lancet 4,362,1125; 2003; (03) 14501-1
• 8 Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 2002; 24 (01) 24-28
• 9 Gururaj G. Road traffic deaths, injuries and disabilities in India: current scenario. Natl Med J India 2008; 21 (01) 14-20
• 10 Narayan RK, Michel ME, Ansell B. et al. Clinical trials in head injury. J Neurotrauma 2002; 19 (05) 503-557
• 11 Pfenninger J, Santi A. Severe traumatic brain injury in children–are the results improving?. Swiss Med Wkly 2002; 132 (9-10) 116-120
• 12 Raphaely RC, Swedlow DB, Downes JJ, Bruce DA. Management of severe pediatric head trauma. Pediatr Clin North Am 1980; 27 (03) 715-727
• 13 Lang DA, Teasdale GM, Macpherson P, Lawrence A. Diffuse brain swelling after head injury: more often malignant in adults than children?. J Neurosurg 1994; 80 (04) 675-680
• 14 Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Br J Neurosurg 2002; 16 (03) 220-242
• 15 Eggensperger Wymann NM, Hölzle A, Zachariou Z, Iizuka T. Pediatric craniofacial trauma. J Oral Maxillofac Surg 2008; 66 (01) 58-64
• 16 Roeder RA, Thaller S. Unique features of the pediatric craniofacial anatomy. J Craniofac Surg 2011; 22 (02) 392-394
• 17 Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 2005; 57 (06) 1173-1182
• 18 Liesemer K, Riva-Cambrin J, Bennett KS. et al. Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury. Pediatr Crit Care Med 2014; 15 (06) 554-562
• 19 Maas AI, Steyerberg EW, Butcher I. et al. Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24 (02) 303-314
• 20 Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT. Workshop Scientific Team and Advisory Panel Members. Classification of traumatic brain injury for targeted therapies. J Neurotrauma 2008; 25 (07) 719-738
• 21 Hirsch W, Schobess A, Eichler G, Zumkeller W, Teichler H, Schluter A. Severe head trauma in children: cranial computer tomography and clinical consequences. Paediatr Anaesth 2002; 12 (04) 337-344
• 22 Lobato RD, Cordobes F, Rivas JJ. et al. Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 1983; 59 (05) 762-774
• 23 The Brain Trauma Foundation Guidelines. Computed tomography scan features. J Neurotrauma 2000; 17 (6-7) 597-627
• 24 Sarkar K, Keachie K, Nguyen U, Muizelaar JP, Zwienenberg-Lee M, Shahlaie K. Computed tomography characteristics in pediatric versus adult traumatic brain injury. J Neurosurg Pediatr 2014; 13 (03) 307-314
• 25 Courchesne E, Chisum HJ, Townsend J. et al. Normal brain development and aging: quantitative analysis at in vivo MR imaging in healthy volunteers. Radiology 2000; 216 (03) 672-682