Vasospasm in children with traumatic brain injury.
OBJECTIVE
To determine the incidence of vasospasm in children who have suffered moderate to severe traumatic brain injury.


METHODS
A prospective observational pilot study in a 24-bed pediatric intensive care unit was performed. Twenty-two children aged 7 months to 14 years with moderate to severe traumatic brain injury as indicated by Glasgow Coma Score </=12 and abnormal head imaging were enrolled. Transcranial Doppler ultrasound was performed to identify and follow vasospasm. Patients with a flow velocity in the middle cerebral artery (MCA) >120 cm/s were considered to have vasospasm by criterion A. If flow velocity in the MCA was >120 cm/s and the Lindegaard ratio was >3, vasospasm was considered to be present by criterion B. Patients with basilar artery (BA) flow velocity >90 cm/s met criteria for vasospasm in the posterior circulation (criterion C).


RESULTS
In the MCA, 45.5% of patients developed vasospasm based on criterion A and 36.3% developed vasospasm based on criterion B. A total of 18.2% of patients developed vasospasm in the BA by criterion C. Typical day of onset of vasospasm was hospital day 2-3. Duration of vasospasm in the anterior circulation was 4 +/- 2 days based on criteria A and 3 +/- 1 days based on criteria B. Vasospasm in the posterior circulation persisted for 2 +/- 1 days.


CONCLUSIONS
Using the adult criteria outlined above to diagnose vasospasm, a significant proportion of pediatric patients who have suffered moderate to severe traumatic brain injury develop vasospasm during the course of their treatment.
O'Brien
Nicole Fortier
NF
Nationwide Children's Hospital, Columbus, OH, 43205, USA. Nicole.Obrien@nationwidechildrens.org
Reuter-Rice
Karin E
KE
Khanna
Sandeep
S
Peterson
Bradley M
BM
Quinto
Kenneth B
KB
D000293:Adolescent; D001783:Blood Flow Velocity; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D002560:Cerebrovascular Circulation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D010865:Pilot Projects; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*