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Usiakimi Igbaseimokumo - One of the best experts on this subject based on the ideXlab platform.
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210 Post-Traumatic Seizure in Pediatric Traumatic Brain Injury: Incidence, Risk Factors, and Outcomes in 124,444 Patients
Neurosurgery, 2017Co-Authors: Kavelin Rumalla, Megan Lilley, Mrudula Gandham, Rachana Kombathula, Usiakimi IgbaseimokumoAbstract:Abstract INTRODUCTION Post traumatic seizures (PTS) are the most common complication following a traumatic brain injury (TBI). The nationwide incidence, risk factors, and outcomes associated with PTS in pediatric TBI are not well understood. METHODS We queried the Kids Inpatient Database (2003, 2006, 2009, 2012) using ICD-9-CM codes to identify all patients (age <21) that had a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis of a PTS (780.33, 780.39). Severity of TBI was determined by level of consciousness and nature of the injury (open/closed). Variables included demographics, comorbidity, hospital type, and TBI type. level of consciousness (LOC), open/closed wound, and surgical management. Risk factors for PTS were identified in univariate and multivariable analysis (alpha set at <0.05). RESULTS >The rate of PTS was 6.9% among 124,444 patients hospitalized for TBI. The rate was impacted by LOC: no LOC (6.3%), brief LOC (7.5%), moderate LOC (10.6%), prolonged LOC w/baseline return (13.9%), or prolonged LOC w/no return (6.4%). The rate also varied by type of TBI: subdural hematoma (12.0%), Cerebral Laceration (7.4%), subarachnoid hemorrhage (6.5%), concussion (6.0%), and epidural hematoma (4.0%). In multivariable analysis, risk factors for PTS included age 0–5 (compared to 6–10, 11–15, 16–20), African American race, 2 + pre-existing comorbidities, Cerebral contusion/Laceration, subdural hematoma, closed wound, brief LOC, moderate LOC, and prolonged LOC w/baseline return (all P < 0.05). Surgically managed patients were more likely to suffer PTS (10.7% vs. 6.5%, P < 0.0001) unless treated within 24 hours of admission (6.7% vs. 9.6%, P < 0.0001). CONCLUSION PTS is common in children with TBI and is impacted by age, comorbidity, race, and severity/type of injury. Patients with mild to moderate TBI are at the highest risk and prompt surgery is associated with decreased risk of PTS.
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212 Hydrocephalus in Pediatric Traumatic Brain Injury: National Incidence, Risk Factors, and Outcomes in 124,444 Patients
Neurosurgery, 2017Co-Authors: Kavelin Rumalla, Vijay Letchuman, Bharadwaj Jilakara, Akhil Pulumati, Usiakimi IgbaseimokumoAbstract:Abstract INTRODUCTION Hydrocephalus is a well-known and life-threatening sequel of traumatic brain injury (TBI) in adults, but is not as well characterized in children. We investigated the national incidence, risk factors, and outcomes associated with hydrocephalus in pediatric TBI. METHODS The Kids Inpatient Database (KID) is the largest pediatric hospital database in the U.S. and is sampled every 3 years. We queried the KID 2003, 2006, 2009, and 2012 using ICD-9-CM codes to identify all patients (age 0–20) with a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis code for hydrocephalus (331.3-331.5, excluding congenital hydrocephalus [742.3]. Variables included demographics, comorbidities, TBI severity (consciousness, type of wound) complications (medical or neurological), and discharge outcomes. Both univariate and multivariable analysis was utilized to identify factors associated with hydrocephalus and alpha was set at P < 0.05. RESULTS >In 124,444 patients hospitalized for TBI. The average rate of hydrocephalus was 1.0% but was affected by the type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), Cerebral Laceration (0.9%), concussion (0.2%). The risk factors for hydrocephalus in multivariable analysis were age 0–5 (compared to other ages), Medicaid insurance, electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication, and septicemia (all P < 0.05). The likelihood of hydrocephalus was increased among surgically managed patients (6.0% vs. 0.5%) but decreased among those who underwent operation on admission day (0.8% vs. 4.1%) (both P < 0.05). The mortality rate for TBI patients without hydrocephalus was higher (5.4%) than those with hydrocephalus (1.1%). However, average LOS (25 vs. 5 days) and mean total hospital costs ($86,596 vs. $16,791) were greater among patients with hydrocephalus. CONCLUSION Hydrocephalus following TBI in children is relatively uncommon but is more likely in patients with certain demographics, pre-existing comorbidities, and injury patterns and attracts a higher total hospital cost.
Kavelin Rumalla - One of the best experts on this subject based on the ideXlab platform.
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Hydrocephalus in Pediatric Traumatic Brain Injury: National Incidence, Risk Factors, and Outcomes in 124,444 Hospitalized Patients.
Pediatric neurology, 2017Co-Authors: Kavelin Rumalla, Vijay Letchuman, Kyle A. Smith, Paul M. ArnoldAbstract:Abstract Background Hydrocephalus is a life-threatening sequela of traumatic brain injury (TBI) with poorly defined epidemiology in children. Here, we report the national incidence, risk factors, and outcomes associated with post-traumatic hydrocephalus (PTH). Methods The Kids Inpatient Database (2003, 2006, 2009, 2012) was queried using the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes to identify all patients (age 0 to 20) with TBI (850.xx to 854.xx) and noncongenital hydrocephalus (331.3 to 331.5, exclude 742.3). Variables included patient demographics and comorbidities, TBI severity (level of consciousness, injury type), treatment, and outcome-related measures. Risk factors associated with PTH were identified using univariate and multivariable analyses. Results PTH occurred in 1265 of 124,444 patients (1.0%) hospitalized with TBI and was managed by ventriculoperitoneal shunt (32.7%) and extraventricular drain (10.7%). PTH had the highest rate in shaken baby syndrome (6.7%, n = 19) and firearm injury (3.4%, n = 74). PTH varied by type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), Cerebral Laceration (0.9%), concussion (0.2%). Multivariable risk factors for PTH included age zero to five years old (versus six to 20), Medicaid (versus private), electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication (iatrogenic stroke), and septicemia (P Conclusions PTH in children is relatively uncommon compared with adults. Risk factors identified here, along with the influence of surgical intervention, warrant further investigation.
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210 Post-Traumatic Seizure in Pediatric Traumatic Brain Injury: Incidence, Risk Factors, and Outcomes in 124,444 Patients
Neurosurgery, 2017Co-Authors: Kavelin Rumalla, Megan Lilley, Mrudula Gandham, Rachana Kombathula, Usiakimi IgbaseimokumoAbstract:Abstract INTRODUCTION Post traumatic seizures (PTS) are the most common complication following a traumatic brain injury (TBI). The nationwide incidence, risk factors, and outcomes associated with PTS in pediatric TBI are not well understood. METHODS We queried the Kids Inpatient Database (2003, 2006, 2009, 2012) using ICD-9-CM codes to identify all patients (age <21) that had a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis of a PTS (780.33, 780.39). Severity of TBI was determined by level of consciousness and nature of the injury (open/closed). Variables included demographics, comorbidity, hospital type, and TBI type. level of consciousness (LOC), open/closed wound, and surgical management. Risk factors for PTS were identified in univariate and multivariable analysis (alpha set at <0.05). RESULTS >The rate of PTS was 6.9% among 124,444 patients hospitalized for TBI. The rate was impacted by LOC: no LOC (6.3%), brief LOC (7.5%), moderate LOC (10.6%), prolonged LOC w/baseline return (13.9%), or prolonged LOC w/no return (6.4%). The rate also varied by type of TBI: subdural hematoma (12.0%), Cerebral Laceration (7.4%), subarachnoid hemorrhage (6.5%), concussion (6.0%), and epidural hematoma (4.0%). In multivariable analysis, risk factors for PTS included age 0–5 (compared to 6–10, 11–15, 16–20), African American race, 2 + pre-existing comorbidities, Cerebral contusion/Laceration, subdural hematoma, closed wound, brief LOC, moderate LOC, and prolonged LOC w/baseline return (all P < 0.05). Surgically managed patients were more likely to suffer PTS (10.7% vs. 6.5%, P < 0.0001) unless treated within 24 hours of admission (6.7% vs. 9.6%, P < 0.0001). CONCLUSION PTS is common in children with TBI and is impacted by age, comorbidity, race, and severity/type of injury. Patients with mild to moderate TBI are at the highest risk and prompt surgery is associated with decreased risk of PTS.
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212 Hydrocephalus in Pediatric Traumatic Brain Injury: National Incidence, Risk Factors, and Outcomes in 124,444 Patients
Neurosurgery, 2017Co-Authors: Kavelin Rumalla, Vijay Letchuman, Bharadwaj Jilakara, Akhil Pulumati, Usiakimi IgbaseimokumoAbstract:Abstract INTRODUCTION Hydrocephalus is a well-known and life-threatening sequel of traumatic brain injury (TBI) in adults, but is not as well characterized in children. We investigated the national incidence, risk factors, and outcomes associated with hydrocephalus in pediatric TBI. METHODS The Kids Inpatient Database (KID) is the largest pediatric hospital database in the U.S. and is sampled every 3 years. We queried the KID 2003, 2006, 2009, and 2012 using ICD-9-CM codes to identify all patients (age 0–20) with a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis code for hydrocephalus (331.3-331.5, excluding congenital hydrocephalus [742.3]. Variables included demographics, comorbidities, TBI severity (consciousness, type of wound) complications (medical or neurological), and discharge outcomes. Both univariate and multivariable analysis was utilized to identify factors associated with hydrocephalus and alpha was set at P < 0.05. RESULTS >In 124,444 patients hospitalized for TBI. The average rate of hydrocephalus was 1.0% but was affected by the type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), Cerebral Laceration (0.9%), concussion (0.2%). The risk factors for hydrocephalus in multivariable analysis were age 0–5 (compared to other ages), Medicaid insurance, electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication, and septicemia (all P < 0.05). The likelihood of hydrocephalus was increased among surgically managed patients (6.0% vs. 0.5%) but decreased among those who underwent operation on admission day (0.8% vs. 4.1%) (both P < 0.05). The mortality rate for TBI patients without hydrocephalus was higher (5.4%) than those with hydrocephalus (1.1%). However, average LOS (25 vs. 5 days) and mean total hospital costs ($86,596 vs. $16,791) were greater among patients with hydrocephalus. CONCLUSION Hydrocephalus following TBI in children is relatively uncommon but is more likely in patients with certain demographics, pre-existing comorbidities, and injury patterns and attracts a higher total hospital cost.
Barbara Barlow - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology and prevention of traffic injuries to urban children and adolescents.
Pediatrics, 1999Co-Authors: Maureen S. Durkin, Danielle Laraque, Ilona Lubman, Barbara BarlowAbstract:Objectives. To describe the incidence of severe traffic injuries before and after implementation of a comprehensive, hospital-initiated injury prevention program aimed at the prevention of traffic injuries to school-aged children in an urban community. Materials and Methods. Hospital discharge and death certificate data on severe pediatric injuries (ie, injuries resulting in hospital admission and/or death to persons age 1 hour, Cerebral Laceration and/or Cerebral hemor- rhage), and 36.9% sustained minor head trauma (skull fracture and/or concussion with no loss of consciousness >1 hour and no major head injury). The percentage of injured children with major and minor head trauma was higher among those injured in traffic than among those injured by all other means (43.2% vs 14.2%, respectively; x 2 5 336; degrees of freedom 5 1). The percentages of children sustaining head trauma were 45.4% of those who were injured as pedestrians, 40.2% of those who were injured as bicyclists, and 38.9% of those who were injured as motor vehicle occupants.
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The Epidemiology of Urban Pediatric Neurological Trauma: Evaluation of, and Implications for, Injury Prevention Programs
Neurosurgery, 1998Co-Authors: Maureen S. Durkin, Barbara Barlow, S. Olsen, A. Virella, E. S. ConnollyAbstract:OBJECTIVE: To describe the incidence and causes of pediatric head, spinal cord, and peripheral nerve injuries in an urban setting and to assess the implications of these data for injury prevention programs. METHODS: Pediatric deaths and hospital admissions secondary to neurological trauma included in the Northern Manhattan Injury Surveillance System from 1983 to 1992 were linked to census counts to compute incidence rates. Rates before the implementation of a nonspecific injury prevention program were compared with rates after the implementation, and rates for the target population were compared to rates for the control population. Rates were analyzed on the basis of the cause of injury as well as the age, gender, and neighborhood income level of the injured. RESULTS: The incidence of neurological injuries resulting in hospitalization or death was 155 incidents per 100,000 population per year; the mortality rate was 6 people per 100,000 population per year. Neurological injuries represented 18% of all pediatric injuries and accounted for 23% of all traumatic deaths. Spinal cord and peripheral nerve injuries were relatively rare (5%) compared to head injuries (95%). Minor head injuries, including isolated cranial fractures, minor concussions ( 1 h loss of consciousness), Cerebral Laceration/contusion, intraCerebral hemorrhage, and unspecified major injuries, were less common (18% of all neurological injuries). Boys were more often affected than girls at every age, and this preference increased with age. Children younger than 1 year showed the highest incidence of both major and minor injuries. One-to 4-year olds showed the lowest rates, with steady increases thereafter. Traffic accidents and falls were the leading causes (38 and 34%, respectively), and assaults were the next leading causes (12%). Among children admitted to surveillance system hospitals, falls were most common in children younger than 4 years, pedestrian motor vehicle accidents were most common in late childhood, and assaults were most common in early adolescence. Case:fatality rates were 5 to 7% for all age groups except 5- to 12-year-olds, for whom the case:fatality rate was 1.9%. Residence in a low-income neighborhood was associated with an increased risk of injury (rate ratio, 1.71; confidence interval, 95%, 1.54, 1.89). The average hospitalization cost per injury was $8502. Medicaid (54%) and other government sources (5%) covered the majority of expenses, including indirect reimbursement of usually uncollected self-pay billing (19%). Although injury incidence rates fell in both the control and intervention cohorts during implementation of a nonspecific injury prevention program, targeted age and population groups demonstrated greater relative reductions in injuries than nontargeted ones, suggesting a positive effect. CONCLUSIONS: Deaths and hospital admissions secondary to pediatric neurological trauma represent a significant public health problem, with the majority of the direct cost being born by government agencies. Future efforts to prevent neurological trauma in children who live in inner cities should focus on families with low incomes and provide novel education programs regarding infant abuse, infant neglect, and infant injury avoidance. Age-appropriate school-based programs should also be developed to address traffic safety and conflict resolution.
Maureen S. Durkin - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology and prevention of traffic injuries to urban children and adolescents.
Pediatrics, 1999Co-Authors: Maureen S. Durkin, Danielle Laraque, Ilona Lubman, Barbara BarlowAbstract:Objectives. To describe the incidence of severe traffic injuries before and after implementation of a comprehensive, hospital-initiated injury prevention program aimed at the prevention of traffic injuries to school-aged children in an urban community. Materials and Methods. Hospital discharge and death certificate data on severe pediatric injuries (ie, injuries resulting in hospital admission and/or death to persons age 1 hour, Cerebral Laceration and/or Cerebral hemor- rhage), and 36.9% sustained minor head trauma (skull fracture and/or concussion with no loss of consciousness >1 hour and no major head injury). The percentage of injured children with major and minor head trauma was higher among those injured in traffic than among those injured by all other means (43.2% vs 14.2%, respectively; x 2 5 336; degrees of freedom 5 1). The percentages of children sustaining head trauma were 45.4% of those who were injured as pedestrians, 40.2% of those who were injured as bicyclists, and 38.9% of those who were injured as motor vehicle occupants.
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The Epidemiology of Urban Pediatric Neurological Trauma: Evaluation of, and Implications for, Injury Prevention Programs
Neurosurgery, 1998Co-Authors: Maureen S. Durkin, Barbara Barlow, S. Olsen, A. Virella, E. S. ConnollyAbstract:OBJECTIVE: To describe the incidence and causes of pediatric head, spinal cord, and peripheral nerve injuries in an urban setting and to assess the implications of these data for injury prevention programs. METHODS: Pediatric deaths and hospital admissions secondary to neurological trauma included in the Northern Manhattan Injury Surveillance System from 1983 to 1992 were linked to census counts to compute incidence rates. Rates before the implementation of a nonspecific injury prevention program were compared with rates after the implementation, and rates for the target population were compared to rates for the control population. Rates were analyzed on the basis of the cause of injury as well as the age, gender, and neighborhood income level of the injured. RESULTS: The incidence of neurological injuries resulting in hospitalization or death was 155 incidents per 100,000 population per year; the mortality rate was 6 people per 100,000 population per year. Neurological injuries represented 18% of all pediatric injuries and accounted for 23% of all traumatic deaths. Spinal cord and peripheral nerve injuries were relatively rare (5%) compared to head injuries (95%). Minor head injuries, including isolated cranial fractures, minor concussions ( 1 h loss of consciousness), Cerebral Laceration/contusion, intraCerebral hemorrhage, and unspecified major injuries, were less common (18% of all neurological injuries). Boys were more often affected than girls at every age, and this preference increased with age. Children younger than 1 year showed the highest incidence of both major and minor injuries. One-to 4-year olds showed the lowest rates, with steady increases thereafter. Traffic accidents and falls were the leading causes (38 and 34%, respectively), and assaults were the next leading causes (12%). Among children admitted to surveillance system hospitals, falls were most common in children younger than 4 years, pedestrian motor vehicle accidents were most common in late childhood, and assaults were most common in early adolescence. Case:fatality rates were 5 to 7% for all age groups except 5- to 12-year-olds, for whom the case:fatality rate was 1.9%. Residence in a low-income neighborhood was associated with an increased risk of injury (rate ratio, 1.71; confidence interval, 95%, 1.54, 1.89). The average hospitalization cost per injury was $8502. Medicaid (54%) and other government sources (5%) covered the majority of expenses, including indirect reimbursement of usually uncollected self-pay billing (19%). Although injury incidence rates fell in both the control and intervention cohorts during implementation of a nonspecific injury prevention program, targeted age and population groups demonstrated greater relative reductions in injuries than nontargeted ones, suggesting a positive effect. CONCLUSIONS: Deaths and hospital admissions secondary to pediatric neurological trauma represent a significant public health problem, with the majority of the direct cost being born by government agencies. Future efforts to prevent neurological trauma in children who live in inner cities should focus on families with low incomes and provide novel education programs regarding infant abuse, infant neglect, and infant injury avoidance. Age-appropriate school-based programs should also be developed to address traffic safety and conflict resolution.
David L. Kaplan - One of the best experts on this subject based on the ideXlab platform.
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A 3D Tissue Model of Traumatic Brain Injury with Excitotoxicity That Is Inhibited by Chronic Exposure to Gabapentinoids.
Biomolecules, 2020Co-Authors: Nicolas Rouleau, Mattia Bonzanni, Joshua D. Erndt-marino, Katja Sievert, Camila G. Ramirez, William Rusk, Michael Levin, David L. KaplanAbstract:Injury progression associated with Cerebral Laceration is insidious. Following the initial trauma, brain tissues become hyperexcitable, begetting further damage that compounds the initial impact over time. Clinicians have adopted several strategies to mitigate the effects of secondary brain injury; however, higher throughput screening tools with modular flexibility are needed to expedite mechanistic studies and drug discovery that will contribute to the enhanced protection, repair, and even the regeneration of neural tissues. Here we present a novel bioengineered cortical brain model of traumatic brain injury (TBI) that displays characteristics of primary and secondary injury, including an outwardly radiating cell death phenotype and increased glutamate release with excitotoxic features. DNA content and tissue function were normalized by high-concentration, chronic administrations of gabapentinoids. Additional experiments suggested that the treatment effects were likely neuroprotective rather than regenerative, as evidenced by the drug-mediated decreases in cell excitability and an absence of drug-induced proliferation. We conclude that the present model of traumatic brain injury demonstrates validity and can serve as a customizable experimental platform to assess the individual contribution of cell types on TBI progression, as well as to screen anti-excitotoxic and pro-regenerative compounds.