Neurological Deterioration After Mild TBI

J Millichap

doi:10.15844/pedneurbriefs-28-1-7

Author:

J Gordon Millichap

Northwestern University Feinberg School of Medicine, US

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Abstract

How to Cite: Millichap, J.G., 2014. Neurological Deterioration After Mild TBI. Pediatric Neurology Briefs, 28(1), pp.6–6. DOI: http://doi.org/10.15844/pedneurbriefs-28-1-7

Investigators from UMDNJ-New Jersey Medical School, Newark, NJ, studied the cause, course, and outcomes of 757 patients who were admitted over 54 months following mild head injury (MHI) complicated by intracranial hemorrhage (ICH). Of these, 31 (4.1%) experienced delayed neurological deterioration (DND)(Glasgow Coma Scale score decrease >2); 87% deteriorated within 24 hours of admission, 68% had progressive ICH, 32% had medical causes for DND, and 23% died. Factors associated with mortality included age >60 years, coagulopathy, and change in Marshall CT classification. In adolescents and adults the incidence of DND is low but carries significant morbidity and mortality if it results from progressive ICH. [1]

COMMENTARY. This study shows that the majority (96%) of adult and adolescent patients with mild head injury plus ICH has a good prognosis and remains stable without neurological decline. In the 4% with delayed neurological deterioration, 87% deteriorated within the first 24 hours, mainly because of a progressive ICH. Coagulopathy is an important risk factor and the diagnosis and correction during transmission to a trauma center improves prognosis [2]. Since age (>60 years) is found to be a risk factor [3], children and adolescents may be expected to carry a low risk of delayed neurological deterioration. The following study, however, emphasizes a residual cognitive disability in TBI children aged 7-18 years.

Residual Cognitive Disability in Children with TBI. On admission to inpatient rehabilitation, patients with TBI had more cognitive disability than those with other injuries, and TBI patients had significant residual cognitive disability on discharge [4].

References

Choudhry, OJ, Prestigiacomo, CJ, Gala, N, Slasky, S and Sifri, ZC (2013). Delayed neurological deterioration after mild head injury: Cause, temporal course, and outcomes. Neurosurgery Nov 201373(5): 753–60, DOI: https://doi.org/10.1227/NEU.0000000000000105 [PubMed]

Brown, CV Sowery, L Curry, E Valadka, AB Glover, CS Grabarkewitz, K et al. (2012). Recombinant factor VIIa to correct coagulopathy in patients with traumatic brain injury presenting to outlying facilities before transfer to the regional trauma center. Am Surg Jan 201278(1): 57–60. [PubMed]

Mosenthal, AC Livingston, DH Lavery, RF Knudson, MM Lee, S Morabito, D et al. (2004). The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma May 200456(5): 1042–8. [PubMed]

Zonfrillo, MR, Durbin, DR, Winston, FK, Zhang, X and Stineman, MG (2014). Residual cognitive disability after completion of inpatient rehabilitation among injured children. J Pediatr Jan 2014164(1): 130–5, DOI: https://doi.org/10.1016/j.jpeds.2013.09.022 [PubMed]

[CIT0001] Choudhry, OJ, Prestigiacomo, CJ, Gala, N, Slasky, S and Sifri, ZC (2013). Delayed neurological deterioration after mild head injury: Cause, temporal course, and outcomes. Neurosurgery Nov 201373(5): 753–60, DOI: https://doi.org/10.1227/NEU.0000000000000105 [PubMed]

[CIT0002] Brown, CV Sowery, L Curry, E Valadka, AB Glover, CS Grabarkewitz, K et al. (2012). Recombinant factor VIIa to correct coagulopathy in patients with traumatic brain injury presenting to outlying facilities before transfer to the regional trauma center. Am Surg Jan 201278(1): 57–60. [PubMed]

[CIT0003] Mosenthal, AC Livingston, DH Lavery, RF Knudson, MM Lee, S Morabito, D et al. (2004). The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma May 200456(5): 1042–8. [PubMed]

[CIT0004] Zonfrillo, MR, Durbin, DR, Winston, FK, Zhang, X and Stineman, MG (2014). Residual cognitive disability after completion of inpatient rehabilitation among injured children. J Pediatr Jan 2014164(1): 130–5, DOI: https://doi.org/10.1016/j.jpeds.2013.09.022 [PubMed]

Reading: Neurological Deterioration After Mild TBI

Traumatic Disorders

Neurological Deterioration After Mild TBI

Author:

J Gordon Millichap

Northwestern University Feinberg School of Medicine, US

X close

Abstract

References