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Vasospasm in children with traumatic brain injury

Nicole Fortier O'Brien1, Karin E Reuter-Rice, Sandeep Khanna

  • 1Nationwide Children's Hospital, Columbus, OH, 43205, USA. Nicole.Obrien@nationwidechildrens.org

Intensive Care Medicine
|January 22, 2010
PubMed

Insights

Pediatric patients with moderate to severe traumatic brain injury frequently develop vasospasm in the middle cerebral artery (MCA) and basilar artery (BA). This study used adult criteria to identify vasospasm in children, finding significant incidence rates.

Area of Science:

  • Pediatric intensive care
  • Neurocritical care
  • Neurology

Background:

  • Traumatic brain injury (TBI) in children can lead to serious complications.
  • Vasospasm, a narrowing of blood vessels in the brain, is a known complication of TBI, but its incidence in pediatric populations is not well-defined.

Purpose of the Study:

  • To determine the incidence of vasospasm in children with moderate to severe traumatic brain injury.
  • To evaluate the applicability of adult vasospasm diagnostic criteria in a pediatric cohort.

Main Methods:

  • A prospective observational pilot study was conducted in a pediatric intensive care unit.
  • Twenty-two children (7 months to 14 years) with moderate to severe TBI (Glasgow Coma Scale ≤12, abnormal head imaging) were enrolled.
  • Transcranial Doppler ultrasound was used to assess flow velocities in the middle cerebral artery (MCA) and basilar artery (BA), applying established criteria for vasospasm detection.

Main Results:

  • Vasospasm in the MCA occurred in 45.5% (criterion A) and 36.3% (criterion B) of patients.
  • Vasospasm in the BA was observed in 18.2% of patients (criterion C).
  • The typical onset was hospital days 2-3, with durations of 4±2 days (MCA, criterion A) and 3±1 days (MCA, criterion B), and 2±1 days (BA).

Conclusions:

  • A significant proportion of pediatric patients with moderate to severe TBI develop vasospasm.
  • Adult criteria for diagnosing vasospasm appear applicable in identifying this complication in children.
  • Further research is warranted to confirm these findings in larger pediatric cohorts.
Abstract

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