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Computed tomography characteristics in pediatric versus adult traumatic brain injury
Korak Sarkar1, Krista Keachie, UyenThao Nguyen
1Departments of Neurology and.
Insights
Pediatric traumatic brain injury (TBI) shows distinct CT scan findings compared to adults, with children more prone to skull fractures and epidural hematomas. These differences are crucial for accurate diagnosis and treatment planning in pediatric TBI cases.
Area of Science:
- Neuroscience
- Radiology
- Pediatric Medicine
Background:
- Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children.
- Computed tomography (CT) scans are vital for TBI classification and clinical management.
- Understanding radiographic differences between pediatric and adult TBI is essential for accurate assessment.
Purpose of the Study:
- To investigate and compare the radiographic findings on CT scans between adult and pediatric patients with traumatic brain injury.
- To identify specific differences in TBI manifestations on CT scans in pediatric versus adult populations.
Main Methods:
- Retrospective analysis of 1206 nonpenetrating TBI cases from a Level 1 trauma center registry.
- Data collected over a 30-month period, including adult and pediatric patient cohorts.
- Comparison of demographic data, Glasgow Coma Scale (GCS) scores, and CT scan findings.
Main Results:
- Pediatric TBI patients were significantly more likely to exhibit skull fractures (OR 3.21) and epidural hematomas (OR 1.96).
- Pediatric TBI was less frequently associated with contusions, subdural hematomas, subarachnoid hemorrhages, or basal cistern compression.
- Lower Rotterdam CT scores were observed in the pediatric group (2.3 vs. 2.6).
Conclusions:
- Significant differences exist in CT findings between pediatric and adult TBI, irrespective of clinical severity (GCS).
- These radiographic disparities may stem from anatomical variations, biomechanical factors, and differing injury mechanisms.
- Recognizing unique pediatric TBI characteristics is vital for clinical trial design and outcome prediction models.
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.
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