Validating the Brain Injury Guidelines in a Pediatric Population with Mild Traumatic Brain Injury and Intracranial Injury at a Level I Trauma Center.

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Journal of neurotrauma Pub Date : 2024-11-07 DOI:10.1089/neu.2024.0130
Nina Yu, Jose Castillo, Jonathan E Kohler, James P Marcin, Daniel K Nishijima, Jonathan Mo, Lori Kennedy, Kiarash Shahlaie, Marike Zwienenberg
{"title":"Validating the Brain Injury Guidelines in a Pediatric Population with Mild Traumatic Brain Injury and Intracranial Injury at a Level I Trauma Center.","authors":"Nina Yu, Jose Castillo, Jonathan E Kohler, James P Marcin, Daniel K Nishijima, Jonathan Mo, Lori Kennedy, Kiarash Shahlaie, Marike Zwienenberg","doi":"10.1089/neu.2024.0130","DOIUrl":null,"url":null,"abstract":"<p><p>Children with mild traumatic brain injury (mTBI) and intracranial injury (ICI) often receive unnecessary imaging and hospital admission, leading to avoidable burdens on patients and health systems. While most of these patients do not develop critical neurological injuries, identifying those at risk would allow for a more optimal determination of the appropriate level of initial emergency care. The Brain Injury Guidelines (BIG) were developed as a triage tool to identify adult patients with mTBI and ICI who can benefit from repeat imaging, hospital admission, or neurosurgical consultation. Here, we sought to validate BIG in children at a Level I trauma center and determine if the BIG algorithm can accurately identify which patients with mTBI/ICI have critical neurosurgical injuries. We hypothesize that the BIG can identify critical neurological injuries more accurately than the Glasgow Coma Scale (GCS) alone and that more severe injury according to BIG is associated with worse patient outcome. We retrospectively reviewed TBI admissions at a single center (2017-2023) using an institutional registry. Patients included (0-17 years) had an initial head computerized tomography scan with ICI and a GCS of 14-15. Patients were retrospectively classified into the BIG categories (BIG 1, 2, or 3). Medical records were reviewed to identify clinically important TBI (ciTBI): death, neurological deterioration, neurosurgical intervention, intubation >24 h, or hospital admission >48 h due to TBI. Repeat imaging studies obtained were evaluated for progression of injury. The incidence of clinically important TBI (ciTBI) and imaging progression were recorded and compared across BIG categories. Outcomes were evaluated using the Glasgow Outcome Score Extended (GOS-E) 6 months after injury. Univariable and chi-square tests were used to analyze comparisons. Overall, 804 subjects were included in the analysis of which 551 (68.5%) were transfers. Overall, 175 (21.8%) patients had a BIG 1, 402 (50.0%) a BIG 2, and 227 (28.2%) a BIG 3 injury. CiTBI occurred among 64 (8.0%) patients overall, and in 1 (0.6%), 4 (1.0%), and 59 (26.0%) of the BIG 1, 2, and 3 injuries (<i>p</i> < 0.0001). Progression on repeat imaging associated with neurological decline, neurosurgical intervention or resulting in additional evaluation was noted in 0 (0%), 2 (0.5%), and 41 (18.0%) of the BIG 1, 2, and 3 injuries (<i>p</i> < 0.001). Amongst 471 patients (58.6%) with available 6-month patient outcomes, 98% had a GOS-E ≥5 and no outcome difference between BIG categories was observed. Risk stratification of mild TBI using BIG allowed for reasonable identification of children who subsequently develop ciTBI, suggesting that BIG classification can aid in triage and management of patients who might benefit from neurosurgical consultation, repeat imaging, and potentially transfer to a dedicated trauma center. More severe injury according to BIG was not associated with a worse patient outcome.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurotrauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/neu.2024.0130","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Children with mild traumatic brain injury (mTBI) and intracranial injury (ICI) often receive unnecessary imaging and hospital admission, leading to avoidable burdens on patients and health systems. While most of these patients do not develop critical neurological injuries, identifying those at risk would allow for a more optimal determination of the appropriate level of initial emergency care. The Brain Injury Guidelines (BIG) were developed as a triage tool to identify adult patients with mTBI and ICI who can benefit from repeat imaging, hospital admission, or neurosurgical consultation. Here, we sought to validate BIG in children at a Level I trauma center and determine if the BIG algorithm can accurately identify which patients with mTBI/ICI have critical neurosurgical injuries. We hypothesize that the BIG can identify critical neurological injuries more accurately than the Glasgow Coma Scale (GCS) alone and that more severe injury according to BIG is associated with worse patient outcome. We retrospectively reviewed TBI admissions at a single center (2017-2023) using an institutional registry. Patients included (0-17 years) had an initial head computerized tomography scan with ICI and a GCS of 14-15. Patients were retrospectively classified into the BIG categories (BIG 1, 2, or 3). Medical records were reviewed to identify clinically important TBI (ciTBI): death, neurological deterioration, neurosurgical intervention, intubation >24 h, or hospital admission >48 h due to TBI. Repeat imaging studies obtained were evaluated for progression of injury. The incidence of clinically important TBI (ciTBI) and imaging progression were recorded and compared across BIG categories. Outcomes were evaluated using the Glasgow Outcome Score Extended (GOS-E) 6 months after injury. Univariable and chi-square tests were used to analyze comparisons. Overall, 804 subjects were included in the analysis of which 551 (68.5%) were transfers. Overall, 175 (21.8%) patients had a BIG 1, 402 (50.0%) a BIG 2, and 227 (28.2%) a BIG 3 injury. CiTBI occurred among 64 (8.0%) patients overall, and in 1 (0.6%), 4 (1.0%), and 59 (26.0%) of the BIG 1, 2, and 3 injuries (p < 0.0001). Progression on repeat imaging associated with neurological decline, neurosurgical intervention or resulting in additional evaluation was noted in 0 (0%), 2 (0.5%), and 41 (18.0%) of the BIG 1, 2, and 3 injuries (p < 0.001). Amongst 471 patients (58.6%) with available 6-month patient outcomes, 98% had a GOS-E ≥5 and no outcome difference between BIG categories was observed. Risk stratification of mild TBI using BIG allowed for reasonable identification of children who subsequently develop ciTBI, suggesting that BIG classification can aid in triage and management of patients who might benefit from neurosurgical consultation, repeat imaging, and potentially transfer to a dedicated trauma center. More severe injury according to BIG was not associated with a worse patient outcome.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
在一级创伤中心验证轻度脑外伤和颅内损伤儿科人群脑损伤指南。
患有轻微脑外伤(mTBI)和颅内损伤(ICI)的儿童经常会接受不必要的影像检查和入院治疗,从而给患者和医疗系统造成本可避免的负担。虽然这些患者中的大多数并不会发展成严重的神经损伤,但识别出那些有风险的患者,就能更好地确定适当的初始急救护理级别。脑损伤指南(Brain Injury Guidelines,BIG)是作为一种分流工具而开发的,用于识别可受益于重复成像、入院或神经外科会诊的 mTBI 和 ICI 成年患者。在此,我们试图在一级创伤中心的儿童患者中验证 BIG,并确定 BIG 算法是否能准确识别哪些 mTBI/ICI 患者存在严重的神经外科损伤。我们假设 BIG 能够比单独使用格拉斯哥昏迷量表 (GCS) 更准确地识别危重神经损伤,而且根据 BIG,更严重的损伤与更差的患者预后相关。我们利用机构登记册回顾性审查了一个中心的创伤性脑损伤入院情况(2017-2023 年)。纳入的患者(0-17 岁)均进行了带有 ICI 的初始头部计算机断层扫描,GCS 为 14-15。患者被回顾性地分为 BIG 类别(BIG 1、2 或 3)。对医疗记录进行审查,以确定具有临床意义的创伤性脑损伤(ciTBI):死亡、神经系统恶化、神经外科干预、插管时间大于 24 小时或因创伤性脑损伤入院时间大于 48 小时。对所获得的重复影像学检查结果进行评估,以确定损伤的进展情况。记录临床重要创伤性脑损伤(ciTBI)的发生率和影像学进展情况,并在不同的 BIG 类别中进行比较。受伤 6 个月后,使用格拉斯哥结果评分扩展版(GOS-E)对结果进行评估。比较分析采用单变量和卡方检验。共有 804 名受试者参与分析,其中 551 人(68.5%)为转院者。总体而言,175 名(21.8%)患者的损伤程度为 BIG 1,402 名(50.0%)患者的损伤程度为 BIG 2,227 名(28.2%)患者的损伤程度为 BIG 3。64例(8.0%)患者发生了CiTBI,1例(0.6%)、4例(1.0%)和59例(26.0%)发生了BIG 1、2和3损伤(P < 0.0001)。在 BIG 1、2 和 3 损伤中,分别有 0 例(0%)、2 例(0.5%)和 41 例(18.0%)患者的重复成像结果出现进展,导致神经功能衰退、神经外科干预或进行额外评估(P < 0.001)。在 471 名(58.6%)可获得 6 个月疗效的患者中,98% 的患者 GOS-E ≥5,且未观察到 BIG 类别之间的疗效差异。使用BIG对轻度创伤性脑损伤进行风险分层可合理识别随后发展为ciTBI的儿童,这表明BIG分类有助于对可能受益于神经外科会诊、重复成像以及可能转至专门创伤中心的患者进行分流和管理。根据BIG分类,伤势较重的患者预后较差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Journal of neurotrauma
Journal of neurotrauma 医学-临床神经学
CiteScore
9.20
自引率
7.10%
发文量
233
审稿时长
3 months
期刊介绍: Journal of Neurotrauma is the flagship, peer-reviewed publication for reporting on the latest advances in both the clinical and laboratory investigation of traumatic brain and spinal cord injury. The Journal focuses on the basic pathobiology of injury to the central nervous system, while considering preclinical and clinical trials targeted at improving both the early management and long-term care and recovery of traumatically injured patients. This is the essential journal publishing cutting-edge basic and translational research in traumatically injured human and animal studies, with emphasis on neurodegenerative disease research linked to CNS trauma.
期刊最新文献
Identification of a Therapeutic Window for Neurovascular Unit Repair after Experimental Spinal Cord Injury. Intravenous Immunomodulatory Nanoparticles Prevent Secondary Damage after Traumatic Brain Injury. Altered Dynamic Brain Functional Network Connectivity Related to Visual Network in Spinal Cord Injury. Genetic Differences Modify Anesthetic Preconditioning of Traumatic Brain Injury in Drosophila. Measuring Self-Efficacy for Concussion Recovery: Psychometric Characteristics of the Progressive Activities of Controlled Exertion-Self-Efficacy Scale.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1