Cerebral Blood Flow Velocities and Functional Outcomes in Pediatric Mild Traumatic Brain Injury

Area of Science:

• Pediatric Neurology
• Neurocritical Care
• Medical Imaging

Background:

• Predicting outcomes in children with mild traumatic brain injury (TBI) is challenging.
• Transcranial Doppler (TCD) ultrasound measures cerebral blood flow velocities and has shown utility in moderate-to-severe pediatric TBI and adult mild TBI.
• No studies have correlated TCD findings with outcomes in pediatric mild TBI.

Purpose of the Study:

• To investigate the hypothesis that altered cerebral blood flow, measured by TCD, is associated with poor functional outcomes in children with mild TBI.
• To assess the feasibility of performing TCD in pediatric patients with mild TBI.

Main Methods:

• TCD ultrasound was performed within 24 hours of admission on 60 pediatric patients at a Level 1 children's hospital.
• A subgroup of 28 patients with mild TBI was analyzed.
• Functional outcomes were assessed using the Glasgow Outcome Scale-Extended, Pediatrics (GOS-E Peds) at hospital discharge and 4-6 weeks post-discharge.

Main Results:

• Cerebral blood flow velocities and pulsatility index measured by TCD did not show a statistically significant correlation with GOS-E Peds outcomes at discharge or follow-up.
• Spearman's correlation coefficients for blood flow velocities at discharge were 0.19 (right) and 0.36 (left), and at follow-up were -0.04 (right) and -0.25 (left).
• Correlation coefficients for pulsatility index at discharge were -0.25 (right) and 0.01 (left), and at follow-up were 0.004 (right) and 0.18 (left).

Conclusions:

• While this study did not find a correlation between TCD findings and outcomes in pediatric mild TBI, it demonstrated the feasibility of the TCD procedure in this population.
• Limitations include a small sample size and infrequent occurrence of the outcome of interest.
• Future research with larger cohorts is needed to fully define the role of TCD in managing pediatric mild TBI.