title: Vasospasm in children with traumatic brain injury.
abstract: 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.
authors.affiliation: Nationwide Children's Hospital, Columbus, OH, 43205, USA. Nicole.Obrien@nationwidechildrens.org
authors.forename: Nicole Fortier
authors.initials: NF
authors.lastname: O'Brien
authors.forename: Karin E
authors.initials: KE
authors.lastname: Reuter-Rice
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khanna
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Peterson
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Quinto
mesh_terms: 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*