Predictors of progressive hemorrhagic injury in children with mild traumatic brain injury

By some estimates, 250 per 100,000 children experience traumatic brain injury (TBI) in the United States every year. Although most pediatric TBI is mild, a small number of children with mild TBI develop progressive hemorrhagic injury (PHI), which can prevent injury-related brain bleeds from clotting. Because PHI can be serious or even fatal, early recognition and prevention is key in improving outcomes in children with TBI.

Fortunately, PHI is typically detectable with computed tomography (CT) scans, a common type of imaging that uses x-rays to produce a cross-sectional picture of the brain. Before knowing that a patient may need additional CT scans, clinicians need to be able to recognize symptoms that indicate an impending hemorrhagic injury.

To improve clinicians’ chances of early detection, a group of researchers in China sought to identify predictors of PHI in children with mild TBI. They studied 175 children under fifteen years of age who had sustained a mild TBI. The researchers reviewed the children’s medical records and analyzed their CT scans to look for visual cues related to PHI. They found that:

  • Of the 175 children in the study, 8.6% experienced PHI.
  • Children who experienced vomiting and seizures were at higher risk for developing PHI.
  • Those with more severe TBI and epidural hemorrhaging were also more likely to experience PHI during hospitalization.

PHI is an uncommon but serious complication that may occur as a result of mild TBI. Early detection is possible when clinicians are aware of factors that indicate increased risk for PHI. Symptoms such as vomiting, seizures, and epidural hemorrhage may indicate that additional CT scans are necessary, increasing the likelihood of early detection and improving outcomes.

D Guangfu, Liu H, & Jiang X. Clinical predictors of hemorrhagic injury in children with mild traumatic brain injury. Frontiers in Neurology. (November 2017).

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