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Risk factors for heterotopic ossification in children and adolescents with severe traumatic brain injury
E A Hurvitz1, B R Mandac, G Davidoff
1Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor.
Insights
Heterotopic ossification (HO) affects 14.4% of children with traumatic brain injury (TBI). Older age, longer coma, and limb fractures increase HO risk, impacting functional outcomes.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Rehabilitation Medicine
Background:
- Heterotopic ossification (HO) incidence in pediatric traumatic brain injury (TBI) varies widely (3-20%).
- Previous studies often focus on prolonged coma or briefly mention HO.
- Understanding HO risk factors in pediatric TBI is crucial for patient management.
Purpose of the Study:
- To determine the incidence and characteristics of HO in children and adolescents following TBI.
- To identify risk factors associated with HO development after TBI.
- To evaluate the impact of HO on functional outcomes in this population.
Main Methods:
- Retrospective review of medical records for 90 pediatric patients (<19 years) with TBI and coma >24 hours.
- Mean follow-up of 33.1 months.
- Statistical analysis to identify risk factors and associations (Relative Risk, Confidence Intervals).
Main Results:
- HO incidence was 14.4% (13/90 patients), with hip and knee most commonly affected.
- Children with HO were older (>11 years), had longer coma duration, and higher risk of poor functional outcome.
- Multiple limb fractures showed a trend toward increased HO risk; gender, skull fractures, CT findings, and spasticity were not predictive.
Conclusions:
- HO is a significant complication in pediatric TBI, associated with increased age, coma duration, and poorer functional outcomes.
- Early identification of at-risk children may allow for timely intervention.
- While treatments like etidronate were used, HO-related functional impairments were minimal in this cohort.
Abstract:
Previous reports on the incidence of heterotopic ossification (HO) in children and adolescents with traumatic brain injury (TBI) have ranged from 3% to 20%. These studies mention HO briefly or address patient cohorts with coma more than three months. We reviewed the medical records of 90 children younger than 19 years old, who were comatose more than 24 hours after TBI. Mean followup was 33.1 months (range = 2 to 128 months). Incidence of HO was 14.4% (n = 13). One to five sites were involved, with hip and knee most frequent, followed by shoulder, elbow, and nonjoint sites. Children with HO were older than 11 years (relative risk [RR] = 18.85, confidence interval [CI] = 3.7, 95.7), had a greater length of coma (RR = 7.22, CI = 1.4, 37.1), and had a greater associated risk for poor functional outcome (RR = 2.89, CI = 1.02, 7.9) compared to those without RO. Multiple limb fractures showed a trend toward association with increased incidence of HO. Other factors, including gender, history of skull fracture, brain CAT scan findings, and presence of spasticity, were not predictive of HO. Eleven children were treated with etidronate, four with nonsteroidal antiinflammatory drugs, and one with surgery. Only three children had residual functional impairments attributed to the presence of HO.