Computed tomography characteristics in pediatric versus adult traumatic brain injury

Clinical article

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  • 1 Departments of Neurology and
  • 2 Neurological Surgery; and
  • 3 Clinical and Translational Science Center, University of California, Davis, School of Medicine, Sacramento, California
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Object

Traumatic brain injury (TBI) is a leading cause of injury, hospitalization, and death among pediatric patients. Admission CT scans play an important role in classifying TBI and directing clinical care, but little is known about the differences in CT findings between pediatric and adult patients. The aim of this study was to determine if radiographic differences exist between adult and pediatric TBI.

Methods

The authors retrospectively analyzed TBI registry data from 1206 consecutive patients with nonpenetrating TBI treated at a Level 1 adult and pediatric trauma center over a 30-month period.

Results

The distribution of sex, race, and Glasgow Coma Scale (GCS) score was not significantly different between the adult and pediatric populations; however, the distribution of CT findings was significantly different. Pediatric patients with TBI were more likely to have skull fractures (OR 3.21, p < 0.01) and epidural hematomas (OR 1.96, p < 0.01). Pediatric TBI was less likely to be associated with contusion, subdural hematoma, subarachnoid hemorrhage, or compression of the basal cisterns (p < 0.05). Rotterdam CT scores were significantly lower in the pediatric population (2.3 vs 2.6, p < 0.001).

Conclusions

There are significant differences in the CT findings in pediatric versus adult TBI, despite statistical similarities with regard to clinical severity of injury as measured by the GCS. These differences may be due to anatomical characteristics, the biomechanics of injury, and/or differences in injury mechanisms between pediatric and adult patients. The unique characteristics of pediatric TBI warrant consideration when formulating a clinical trial design or predicting functional outcome using prognostic models developed from adult TBI data.

Abbreviations used in this paper:EDH = epidural hematoma; FDR = false discovery rate; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; IPH = intraparenchymal hematoma; IVH = intraventricular hemorrhage; SAH = subarachnoid hemorrhage; SDH = subdural hematoma; TBI = traumatic brain injury.

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Contributor Notes

Address correspondence to: Kiarash Shahlaie, M.D., Ph.D., Department of Neurological Surgery, University of California, Davis, School of Medicine, 4860 Y St., Ste. 3740, Sacramento, CA 95817. email: kiarash.shahlaie@ucdmc.ucdavis.edu.

Please include this information when citing this paper: published online January 10, 2014; DOI: 10.3171/2013.12.PEDS13223.

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