Key Points
■ Head injury is not a homogeneous phenomenon and has a complex clinical course. There are different mechanisms, varying severity, diversity of injuries, secondary injuries, and effects of age or underlying disease. A highly sensitive clinical decision rule in more than 20,000 children has been derived for the identification of children who should undergo CT imaging after head trauma (moderate evidence).
■ The important CHALICE (Children’s Head injury Algorithm for the prediction of Important Clinical Events) prediction rule (Fig. 7.1) has the potential to improve and standardize the care of pediatric patients with head injuries (strong evidence).
■ Calvarial plain radiographs have a poor sensitivity for identifying pediatric patients with intracranial pathology (moderate to strong evidence) and hence are not recommended unless for highly selected patients with suspected non-accidental trauma. (See Chapters 12 and 13 on non-accidental head injury and non-CNS non-accidental injury, respectively.)
■ CT is the mainstay of imaging in the acute period. The majority of evidence relates to the use of CT for detecting injuries that may require immediate treatment or surgery. Speed, availability, ease of exam, and lesser expense of CT studies remain important factors for using this modality in the acute setting (Table 7.1). Sensitivity of detection also increases with repeat scans in the acute period (strong evidence).
■ It is safe to discharge children with TBI home after a negative CT study (moderate to strong evidence).
■ The sensitivity and specificity of MRI for brain injury is generally superior to CT, although most studies have been retrospective and few direct comparisons have been performed in the recent decade. CT is clearly superior to MRI for the detection of fractures. MRI outperforms CT in detection of most other lesions (limited to moderate evidence), particularly diffuse axonal injury (DAI). MRI allows more detailed analysis of injuries, including metabolic and physiologic measures, but further evidence-based research is needed. There are few pediatric studies regarding the use of imaging and outcome predictions.
■ Accurate prognostic information is important for determining management, but there are different needs for different populations. In severe TBI, information is important for acute patient management, long-term rehabilitation, and family counseling. In mild or moderate TBI, patients with subtle impairments may benefit from counseling and education.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Servadei F, Teasdale G, Merry G [on behalf of the Neurotraumatology Committee of the World Federation of Neurosurgical Societies]. J Neurotrauma 2001;18; 657–664.
Cushman JG, Agarwal N, Fabian TC, Garcia V, Nagy KK, Pasquale MD et al.; EAST Practice Management Guidelines Work Group. J Trauma 2001;51:1016–1026.
Iverson GL, Lovell MR, Smith S, Franzen MD. Brain Inj 2000;14:1057–1061.
Jennett B, Bond M. Lancet 1975;1:480–484.
Jennett B, Snoek J, Bond MR, Brooks N. J Neurol Neurosurg Psychiatr 1981;44:285–293.
van der Naalt J, van Zomeren AH, Sluiter WJ, Minderhoud JM. J Neurol Neurosurg Psychiatr 1999;66:207–213.
Rappaport M, Hall KM, Hopkins K, Belleza BS, Cope DN. Arch Phys Med Rehabil 1982;63:118–123.
Schwab K, Grafman J, Salazar AM, Kraft J. Neurology 1993;43:95–103.
Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM™ instrument), version 5.1. Buffalo (NY): State Univ New York, 1997.
Boake C. Arch Phys Med Rehabil 1996;77:765–772.
Dikmen S, Machamer J, Miller B, Doctor J, Temkin N. J Neurotrauma 2001;18:127–140.
Fiser DH. Assessing the outcome of pediatric intensive care. J Pediatr 1992;121:68–74.
Choi SC, Barnes TY, Bullock R, Germanson TA, Marmarou A et al. J Neurosurg 1994;81:169–173.
Babikian T, Freier MC, Tong KA, Nickerson JP et al. Peds Neurol 2005;33:184–194.
Babikian T, Freier MC, Ashwal S, Riggs ML et al. J MRI 2006;24:801–811.
Torner JC, Choi S, Barnes TY. In Marion D (ed): Traumatic Brain Injury. New York: Thieme, 1998; 9–25.
Adekoya N, Thurman DJ, White DD, Webb KW. MMWR Surveill Summ 2002;1–14.
Teasdale GM. Head injury. J Neurol Neurosurg Psychiatr 1995; 58:526–539.
MacMillan R, Jennett B. BMJ 1981; 282:101–107.
Brookes M, MacMillan R, Cully S et al. J Epidemiol Community Health 1990; 44:147–151.
Meythaler JM, Peduzzi JD, Eleftheriou E, Novack TA. Arch Phys Med Rehabil 2001;82:1461–1471.
Swann IJ, Teasdale GM. Trauma 1999;12:274–278.
Kraus JF, Fife D, Cox P et al. Am J Dis Child 1986; 140:687–693.
Kraus JF, Rock A, Hemyari P. Am J Dis Child 1990; 144:684–691.
Division of Injury Control CfDC. Am J Dis Child 1990; 144:627–646.
Fiser SM, Johnson SB, Fortune JB. Am Surg 1998;64:1088–1093.
Dunning J, Daly JP, Lomas JP et al. Arch Dis Child 2006; 91:885–891.
Palchak M, Holmes J, Vance C et al. Ann Emerg Med 42(4):492–506.
Greenes DS, Schutzman SA. Pediatrics 1999; 104:861–867.
Haydel MJ, Shembekar AD. Ann Emerg Med 2003; 42:507–514.
Haydel MJ, Preston CA, Mills TJ et al. N Engl J Med 2000; 343:100–105.
Dunning J, Daly JP, Malhotra R et al. Arch Dis Child 2004; 89:763–767.
Boran B, Boran P, Barut N. Pediatr Neurosurg 2006; 42:203–207.
Lloyd DA, Carty H, Patterson M et al. Lancet 1997; 349:821–824.
Fearnside M, McDougall P. Aust N Z J Surg 1998;68:58–64.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. J Neurotrauma 2000;17:597–627.
Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH et al. J Neurosurg 2002;96:109–116.
Servadei F, Murray GD, Penny K, Teasdale GM, Dearden M, Iannotti F et al. Neurosurgery 2000;46:70–75.
Stein SC, Spettell C, Young G, Ross SE. Neurosurgery 1993;32:25–30.
Prasad MR, Ewing-Cobbs L, Swank PR, Kramer L. Pediatr Neurosurg 2002;36:64–74.
Pillai S, Praharaj SS, Mohanty A, Sastry Kolluri VR. Pediatr Neurosurg 2001;34:98–103.
Sganzerla EP, Tomei G, Guerra P, Tiberio F, Rampini PM, Gaini SM et al. Child’s Nerv Syst 1989;5:168–171.
Suresh HS, Praharaj SS, Indira Devi B, Shukla D, Sastry Kolluri VR. Neurol India 2003;51:16–18.
Raimondi AJ, Hirschauer J. Childs Brain 1984;11:12–35.
Crouchman M, Rossiter L, Colaco T, Forsyth R. Arch Dis Child 2001;84:120–124.
Fiser DH. J Pediatr 1992;121:69–74.
Orrison WW, Gentry LR, Stimac GK, Tarrell RM, Espinosa MC et al. Am J Neuroradiol 1994;15:351–356.
Ogawa T, Sekino H, Uzura M et al. Acta Neurochir 1992;55(Suppl.):8–10.
Hadley DM, Teasdale GM, Jenkins A, Condon B, Macpherson P, Patterson J et al. Clin Radiol 1988;39:131–139.
Gentry LR, Godersky JC, Thompson B, Dunn VD. AJR 1988;150:673–682.
Levin HS, Aldrich EF, Saydjari C, Eisenberg HM, Foulkes MA, Bellefleur M et al. Neurosurgery 1992;31:435–443.
Hirsch W, Schobess A, Eichler G, Zumkeller W, Teichler H et al. Paediatr Anaesth 2002;12:337–344.
Tomberg T, Rink U, Pikkoja E, Tikk A. Acta Neurochir 1996;138:543–548.
Lang DA, Teasdale GM, Macpherson P, Lawrence A. J Neurosurgery 1994;80:675–680.
Bonnier C, Marique P, Van Hout A et al. J Child Neurol 2007;22: 519–529.
Sigmund GA, Tong KA, Nickerson JP et al. Pediatr Neurol 2007; 36:217–226.
Wilde EA, Bigler ED, Haider JM et al. J Child Neurol 2006; 21:769–776.
Spanos GK, Wilde EA, Bigler ED et al. Am J Neuroradiol 2007; 28:537–542.
Mittl RL Jr, Grossman RI, Hiehle JF et al. Am J Neuroradiol 1994;15:1583–1589.
Gentry LR, Godersky JC, Thompson B. AJR 1988;150: 663–672.
Tong K, Ashwal S, Holshouser B, Shutter L, Herigault G, Haacke EM et al. Radiology 2003;227:332–339.
Tong K, Ashwal S, Holshouser BA. Ann Neurol 2004; 56:36–50.
Scheid R, Preul C, Gruber O, Wiggins C, von Cramon DY. Am J Neuroradiol 2003;24:1049–1056.
Ashikaga R, Araki Y, Ishida O. Neuroradiology 1997;39:239–242.
Levin HS, Mendelsohn D, Lilly MA, Yeakley J, Song J, Scheibel RS et al. Neurosurgery 1997;40:432–440.
Grados MA, Slomine BS, Gerring JP, Vasa R, Bryan N et al. J Neurol Neurosurg Psychiatr 2001;70:350–358.
Blackman JA, Rice SA, Matsumoto JA, Conaway MR, Elgin KM, Patrick PD et al. J Head Trauma Rehabil 2003;18:493–503.
Levin HS, Benavidez DA, Verger-Maestre K, Perachio N, Song J, Mendelsohn DB et al. Neurology 2000;54: 647–653.
Hou DJ, Tong KA, Ashwal S, Oyoyo U, et al. J Neurotrauma 2007;24:1558–1569.
Galloway NR, Tong KA, Ashwal S, Oyoyo U, Obenaus A. J Neurotrauma 2008;25:1153–1162.
Schaefer P, Huisman T, Thierry AGM et al. Radiology 2004; 233:58–66.
Huisman TAGM, Sorensen AG, Hergan K, Gonzalez RG, Schaefer PW. J Comput Assist Tomogr 2003;27:5–11.
Hergan K, Schaefer PW, Sorensen AG, Gonzalez RG, Huisman TAGM. Eur Radiol 2002;12:2536–2541.
Shanmuganathan K, Gullapalli RP, Mirvis SE, Roys S, Murthy P. Am J Neuroradiol 2004;25:539–544.
Wozniak JR, Krach L, Ward E. Arch Clin Neuropsyhcol 2007;22(5):555–568.
Ptak T, Sheridan RL, Rhea JT, Gervasini AA, Yun JH et al. AJR 2003;181:1401–1407.
Arfenakis K, Haughton VM, Carew JD et al. AJNR 2002;23:794–802.
Jones DK, Dardis R, Ervine M, Horsfield MA, Jeffree M et al. Neurosurgery 2000;47:306–314.
Makaroff KL, Cecil KM. Care M et al. Pedicatr Radiol 2005; 35:668–676.
Holshouser BA, Tong K, Ashwal S et al. 2005; 26:1276–1285.
Ashwal S, Holshouser B, Tong K et al. J Neurotrauma 2004; 21:1539–1552.
Ashwal S, Holshouser BA, Tong K et al. Pediatr Res 2004;56:630–638.
Ashwal S, Holshouser BA, Shu SK, Simmons PL, Perkin RM, Tomasi LG et al. Pediatr Neurol 2000; 23:114–125.
Brenner T, Freier MC, Holshouser BA, Burley T, Ashwal S. Pediatr Neurol 2003;28:104–114.
Abdel-Dayem HM, Abu-Judeh H, Kumar M, Atay S, Naddaf S, El-Zeftawy H et al. Clin Nucl Med 1998;23:309–317.
Stamatakis EA, Wilson JT, Hadley DM, Wyper DJ. J Nucl Med 2002;43:476–483.
Kant R, Smith-Seemiller L, Isaac G, Duffy J. Brain Inj 1997;11:115–124.
Gowda NK, Agrawal D, Bal C et al. Am J Neuroradiol 2006; 27:447–451.
Bergsneider M, Hovda DA, McArthur DL, Etchepare M, Huang SC, Sehati N et al. J Head Trauma Rehabil 2001;16:135–148.
Wu HM, Huang SC, Hattori N. J Neurotrauma 2004; 21:149–161.
Lupi A, Bertagnoni G, Salgarello M. Clin Nucl Med 2007; 32:445–451.
Newsome MR, Scheibal RS, Hunter J et al. Neurocase 2007; 13:16–24.
Teasdale G, Teasdale E, Hadley D. J Neurotrauma 1992;9(suppl 1): 249–257.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Tong, K.A., Oyoyo, U.E., Holshouser, B.A., Ashwal, S., Medina, L.S. (2010). Evidence-Based Neuroimaging for Traumatic Brain Injury in Children. In: Medina, L., Applegate, K., Blackmore, C. (eds) Evidence-Based Imaging in Pediatrics. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0922-0_7
Download citation
DOI: https://doi.org/10.1007/978-1-4419-0922-0_7
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-0921-3
Online ISBN: 978-1-4419-0922-0
eBook Packages: MedicineMedicine (R0)