Acute evaluation of pediatric patients with minor traumatic brain injury
Division of Emergency Medicine, Children's National Medical Center, Washington, District of Columbia, USA. Current opinion in pediatrics
(Impact Factor: 2.53).
04/2012; 24(3):307-13. DOI: 10.1097/MOP.0b013e3283531ce6
This review focuses on minor traumatic brain injury (TBI), evaluates the most recent literature regarding clinical prediction rules for the use of cranial computed tomography (CT) in children presenting with minor TBI, reviews the evidence on the need for hospitalization in children with minor TBI, and evaluates the role of S100B testing.
The majority of children presenting to an emergency department (ED) after TBI have a Glasgow Coma Scale (GCS) of 14-15, and the rate of clinically significant intracranial injury is exceedingly rare. Nevertheless, the number of cranial CTs performed in the US has increased dramatically over the past two decades. Several clinical prediction rules have been developed to aid the clinician in identifying children with low-risk TBI, but only the Pediatric Emergency Care Applied Research Network (PECARN) rules have been sufficiently validated to warrant clinical application. Two recent studies provide evidence that children with low-risk TBI can be safely discharged from the ED and do not require prolonged hospitalization for neurologic observation. Lastly, studies evaluating the diagnostic utility of S100B in patients with TBI have shown that it may be a useful adjunct to the clinical evaluation and aid in minimizing neuroimaging.
Clinical prediction rules, most notably the PECARN rules, can be applied to determine children with low-risk TBI and help decrease unnecessary CT use and hospitalizations. S100B testing requires further investigation, but may serve as an adjunct in determining children with low-risk TBI.
Available from: PubMed Central
- "Although S100B is important in development of the central nervous system (CNS)  and is protective of neurons from insults and promotes survival following injury , elevated blood levels of S100B serve as a marker indicative of stroke severity, survival, and progression from hemorrhage to acute thrombosis [90-92] as well as severity of traumatic brain injury . Even seemingly minor head trauma in children and young adults is associated with elevated blood levels of S100B [94,95]. In addition to increased expression of S100B in activated astrocytes in neurological conditions, systemic diseases such as mild to severe liver disease is characterized by dramatic increases in astrocyte-derived S100B expression, encephalopathy, and cognitive decline [96,97]. "
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ABSTRACT: Down syndrome (DS) is the result of triplication of chromosome 21 (trisomy 21) and is the prevailing cause of mental retardation. In addition to the mental deficiencies and physical anomalies noted at birth, triplication of chromosome 21 gene products results in the neuropathological and cognitive changes of Alzheimer's disease (AD). Mapping of the gene that encodes the precursor protein (APP) of the beta-amyloid (Abeta) present in the Abeta plaques in both AD and DS to chromosome 21 was strong evidence that this chromosome 21 gene product was a principal neuropathogenic culprit in AD as well as DS. The discovery of neuroinflammatory changes, including dramatic proliferation of activated glia overexpressing a chromosome 2 gene product - the pluripotent immune cytokine interleukin-1 (IL-1) - and a chromosome 21 gene product - S100B - in the brains of fetuses, neonates, and children with DS opened the possibility that early events in Alzheimer pathogenesis were driven by cytokines. The specific chromosome 21 gene products and the complexity of the mechanisms they engender that give rise to the neuroinflammatory responses noted in fetal development of the DS brain and their potential as accelerators of Alzheimer neuropathogenesis in DS are topics of this review, particularly as they relate to development and propagation of neuroinflammation, the consequences of which are recognized clinically and neuropathologically as Alzheimer's disease.
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ABSTRACT: Traumatic brain injuries (TBIs) are frequent and potentially devastating, affecting up to 2 million new victims in the United States each year. Two percent of these people experience persisting or lifelong disability. TBI is complex and highly variable in terms of affected neuroanatomy, functional impairment, and radiographic presentation, and it is the leading cause of death and disability in children and young adults. It is increasingly recognized as an important indicator of domestic violence victimization. This article introduces the epidemiology, pathobiology and functional brain anatomy, diagnosis, and assessment of TBI. In addition, the role of computed tomography imaging of TBI is detailed.
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To investigate present established routines and standards in managing minor head-injured children in Danish hospitals, a survey of present management practice was conducted.
Materials and methods:
A cross-sectional mail survey, detailing clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up, was performed on all 46 hospitals treating children with minor head injury in Denmark.
Of the 46 hospitals, 33% report having established written criteria for the referral and management of children with minor head injury. Ten (22%) of the 46 hospitals are so-called injury clinics, where only nurses are employed. All state that they use the Glasgow Coma Scale (GCS) and/or the paediatric GCS to assess the level of consciousness; 15% use the paediatric GCS exclusively. None perform routine radiological examinations. Criteria for early discharge are established in 98% of the hospitals. All hospitals provide written instructions for observations at home before discharge.
The management of children with minor head injury varies between hospitals in Denmark. Local management guidelines are either lacking or mainly based on those of adults. Hence, there is a need for the development of minor head injury guidelines specifically designed for the management of children.
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