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Low brain oxygenation and differences in neuropsychological outcomes following severe pediatric TBI

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Abstract

Purpose

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Preventing secondary injury by controlling physiological parameters (e.g. intracranial pressure [ICP], cerebral perfusion pressure [CPP] and brain tissue oxygen [PbtO2]) has a potential to improve outcome. Low PbtO2 is independently associated with poor clinical outcomes in both adults and children. However, no studies have investigated associations between low PbtO2 and neuropsychological and behavioural outcomes following severe pediatric TBI (pTBI).

Methods

We used a quasi-experimental case-control design to investigate these relationships. A sample of 11 TBI patients with a Glasgow Coma Scale score ≤8 who had PbtO2 and ICP monitoring at the Red Cross War Memorial Children’s Hospital underwent neuropsychological evaluation ≥1 year post-injury. Their performance was compared to that of 11 demographically matched healthy controls. We then assigned each TBI participant into one of two subgroups, (1) children who had experienced at least one episode of PbtO2 ≤ 10 mmHg or (2) children for whom PbtO2 > 10 mmHg throughout the monitoring period, and compared their results on neuropsychological evaluation.

Results

TBI participants performed significantly more poorly than controls in several cognitive domains (IQ, attention, visual memory, executive functions and expressive language) and behavioural (e.g. externalizing behaviour) domains. The PbtO2 ≤ 10 mmHg group performed significantly worse than the PbtO2 > 10 mmHg group in several cognitive domains (IQ, attention, verbal memory, executive functions and expressive language), but not on behavioural measures.

Conclusion

Results demonstrate that low PbtO2 may be prognostic of not only mortality but also neuropsychological outcomes.

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Notes

  1. Most pediatric TBIs are closed (as opposed to penetrating) injuries, and the pathophysiology for closed TBIs differs from that of open TBIs [10, 23]. For these reasons, we included only patients who had sustained closed TBIs so as to promote homogeneity in the sample.

  2. Although the recovery period for children following TBI continues well beyond 6 months post-injury, 1 year represents a reasonable plateau phase of recovery for assessment [24, 25].

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Acknowledgments

The South African National Research Foundation, the University of Cape Town’s University Research Committee and the A. W. Mellon Foundation supported this research.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa

    L. E. Schrieff-Elson & K. G. F. Thomas

  2. Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

    U. K. Rohlwink & A. A. Figaji

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  1. L. E. Schrieff-Elson
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  2. K. G. F. Thomas
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  3. U. K. Rohlwink
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  4. A. A. Figaji
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Correspondence to L. E. Schrieff-Elson.

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Schrieff-Elson, L.E., Thomas, K.G.F., Rohlwink, U.K. et al. Low brain oxygenation and differences in neuropsychological outcomes following severe pediatric TBI. Childs Nerv Syst 31, 2257–2268 (2015). https://doi.org/10.1007/s00381-015-2892-2

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