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Published on: August 14, 2019
Predictive value of clinical and radiological findings in inflicted traumatic brain injury
Pilvi Ilves1, Mare Lintrop, Inga Talvik
1Radiology Clinic, Tartu University Hospital, Tartu, Estonia. pilvi.ilves@kliinikum.ee
Insights
Early radiological findings in infants with inflicted traumatic brain injury (ITBI) can predict long-term neurodevelopmental outcomes. Specific indicators like brain edema and white matter changes are crucial for prognosis.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Forensic Medicine
Background:
- Inflicted traumatic brain injury (ITBI) in infants poses significant challenges for predicting long-term neurodevelopmental outcomes.
- Early identification of prognostic factors is crucial for timely intervention and management.
Purpose of the Study:
- To evaluate the predictive value of early radiological investigations for the long-term neurodevelopmental outcome in infants diagnosed with ITBI.
- To identify specific radiological markers that correlate with poor neurodevelopmental outcomes.
Main Methods:
- Retrospective analysis of clinical and radiological data from 24 infants with ITBI.
- Investigations were conducted during acute (1-3 days), early (4 days-3 months), and late (>9 months) post-injury phases.
- Clinical outcomes in survivors were assessed using the Rankin Disability Scale and Glasgow Outcome Score.
Main Results:
- A significant correlation was found between several early radiological findings and poor neurodevelopmental outcomes.
- Indicators included a low initial Glasgow Coma Scale score, development of brain edema, focal basal ganglia changes, new intracerebral focal changes, white matter decrease, and severe atrophy before 3 months.
- 21% of infants experienced poor outcomes (death/severe disability), while 71% had developmental problems.
Conclusions:
- Early clinical and radiological findings in infants with ITBI hold significant prognostic value for long-term neurodevelopmental outcomes.
- These findings can aid clinicians in assessing prognosis and planning future care for affected infants.
Aims:
The aim of this study is to evaluate the value of early radiological investigations in predicting the long-term neurodevelopmental outcome of infants with inflicted traumatic brain injury (ITBI).
Methods:
Clinical and radiological investigations of 24 infants with ITBI were performed during the acute phase of injury (1-3 days), and during the early (4 days up to 3 months) and late (>9 months) postinjury phases. The clinical outcome in survivors (n = 22) was based on the Rankin Disability Scale and the Glasgow Outcome Score.
Results:
Five out of 24 infants (21%) had a poor neurodevelopmental outcome (death and severe disability), 17 infants (71%) had different developmental problems and 2 infants were normal at the mean age of 62 (54-70) (95% CI) months. A low initial Glasgow Coma Scale score of 8 or below [p < 0.05, OR 13.0 (1.3-133.3)], the development of brain oedema [p < 0.005, OR 13.0 (1.6-773)], focal changes in the basal ganglia during the acute phase [p < 0.01, OR 45 (2.1-937.3)], the development of new intracerebral focal changes early postinjury [p < 0.05, OR 24.1(1.0-559.1)], a decrease in white matter [p < 0.01, OR 33 (1.37-793.4)] and the development of severe atrophy before 3 months postinjury [p < 0.05, OR 24 (11.0-559.1)] were significantly correlated with a poor neurodevelopmental outcome.
Conclusions:
Early clinical and radiological findings in ITBI are of prognostic value for neurodevelopmental outcome.
