Lesions in postoperative MRI can predict poor outcome in children with severe TBI
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PHILADELPHIA — Diffuse axonal injury-type lesions in postoperative MRI can predict poor outcomes for children with severe traumatic brain injury, a presenter said at the American Association of Neurological Surgeons annual meeting.
“TBI is the leading cause of death and long-term disability among children worldwide,” Cordell M. Baker, MD, a neurosurgery resident at the University of Utah, said during his presentation. “In the U.S. there are an estimated 630,000 [emergency department] visits for children with TBI and 6,000 deaths every year.”
Baker and colleagues sought to examine ways to predict which children would have worse prognoses, with the goal of helping families better prepare for future health challenges.
“The outcomes of adults and pediatric patients who have sustained TBI is quite different,” he said.
Baker and colleagues conducted a retrospective cohort study and identified 100 children, aged 17 years or younger, with severe TBI defined by a Glasgow Coma Scale score of 8 or less. Eligible participants underwent either craniectomy or craniotomy within 48 hours of arrival, between 2010 and 2019. From the initial cohort, 43 participants (26 male, 17 female) had a postoperative brain MRI within 4 months of surgery.
The primary measure was poor outcome, as defined by the King’s Outcome Scale for Childhood Head Injury (KOSCHI), a five-point scale in which a lower number indicates progressively poorer outcomes, including death. Researchers reported seven participants had a KOSCHI score of 1 to 3, indicating a poor outcome, and the remaining 36 had scores of either 4 or 5, indicating a satisfactory outcome.
Data also showed that the location of diffuse axonal injury-type lesions and the presence of herniation was pivotal for prognosis, and that patients who present with diffuse axonal injury-type lesions in the brainstem, who have evidence of cerebral herniation, have poorer prognoses.
“The majority of children in our series who presented with TBI and who underwent surgery made a satisfactory recovery,” Baker said. “This is a very small sample size, yet it is a very specific population.”