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Published on: November 24, 2017
Low brain oxygenation and differences in neuropsychological outcomes following severe pediatric TBI
L E Schrieff-Elson1, K G F Thomas2, U K Rohlwink3
1ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa. leigh.schrieff-elson@uct.ac.za.
Insights
Low brain tissue oxygen (PbtO2) after severe pediatric traumatic brain injury (TBI) is linked to worse cognitive outcomes. This study found impaired neuropsychological function in children with low PbtO2, highlighting its prognostic value.
Area of Science:
- Pediatric neurosurgery
- Neurocritical care
- Pediatric neurology
Background:
- Severe pediatric traumatic brain injury (TBI) is a significant cause of death and disability.
- Monitoring physiological parameters like intracranial pressure (ICP) and brain tissue oxygen (PbtO2) is crucial for preventing secondary injury.
- Low PbtO2 is a known predictor of poor outcomes in TBI patients.
Purpose of the Study:
- To investigate the association between low PbtO2 and neuropsychological and behavioral outcomes in children with severe TBI.
- To compare cognitive and behavioral performance in TBI survivors with and without episodes of low PbtO2.
Main Methods:
- A quasi-experimental case-control study involving 11 children with severe TBI (Glasgow Coma Scale ≤8) who underwent PbtO2 and ICP monitoring.
- Neuropsychological evaluation was performed at least one year post-injury and compared to 11 matched healthy controls.
- TBI patients were subgrouped based on PbtO2 levels (≤10 mmHg vs. >10 mmHg) for comparative analysis.
Main Results:
- Children with severe TBI demonstrated significantly poorer performance in cognitive domains (IQ, attention, memory, executive functions, language) and behavior compared to controls.
- The subgroup with PbtO2 ≤10 mmHg showed significantly worse outcomes in multiple cognitive domains compared to the PbtO2 >10 mmHg group.
- No significant differences in behavioral measures were found between the PbtO2 subgroups.
Conclusions:
- Low PbtO2 is a potential prognostic indicator for mortality following severe pediatric TBI.
- Findings suggest that low PbtO2 may also predict long-term neuropsychological deficits in pediatric TBI survivors.
Purpose:
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Preventing secondary injury by controlling physiological parameters (e.g. intracranial pressure [ICP], cerebral perfusion pressure [CPP] and brain tissue oxygen [PbtO2]) has a potential to improve outcome. Low PbtO2 is independently associated with poor clinical outcomes in both adults and children. However, no studies have investigated associations between low PbtO2 and neuropsychological and behavioural outcomes following severe pediatric TBI (pTBI).
Methods:
We used a quasi-experimental case-control design to investigate these relationships. A sample of 11 TBI patients with a Glasgow Coma Scale score ≤8 who had PbtO2 and ICP monitoring at the Red Cross War Memorial Children's Hospital underwent neuropsychological evaluation ≥1 year post-injury. Their performance was compared to that of 11 demographically matched healthy controls. We then assigned each TBI participant into one of two subgroups, (1) children who had experienced at least one episode of PbtO2 ≤ 10 mmHg or (2) children for whom PbtO2 > 10 mmHg throughout the monitoring period, and compared their results on neuropsychological evaluation.
Results:
TBI participants performed significantly more poorly than controls in several cognitive domains (IQ, attention, visual memory, executive functions and expressive language) and behavioural (e.g. externalizing behaviour) domains. The PbtO2 ≤ 10 mmHg group performed significantly worse than the PbtO2 > 10 mmHg group in several cognitive domains (IQ, attention, verbal memory, executive functions and expressive language), but not on behavioural measures.
Conclusion:
Results demonstrate that low PbtO2 may be prognostic of not only mortality but also neuropsychological outcomes.
