Predictive value of clinical and radiological findings in inflicted traumatic brain injury.
OBJECTIVE
The aim of this study is to evaluate the value of early radiological investigations in predicting the long-term neurodevelopmental outcome of infants with inflicted traumatic brain injury (ITBI).


METHODS
Clinical and radiological investigations of 24 infants with ITBI were performed during the acute phase of injury (1-3 days), and during the early (4 days up to 3 months) and late (>9 months) postinjury phases. The clinical outcome in survivors (n = 22) was based on the Rankin Disability Scale and the Glasgow Outcome Score.


RESULTS
Five out of 24 infants (21%) had a poor neurodevelopmental outcome (death and severe disability), 17 infants (71%) had different developmental problems and 2 infants were normal at the mean age of 62 (54-70) (95% CI) months. A low initial Glasgow Coma Scale score of 8 or below [p < 0.05, OR 13.0 (1.3-133.3)], the development of brain oedema [p < 0.005, OR 13.0 (1.6-773)], focal changes in the basal ganglia during the acute phase [p < 0.01, OR 45 (2.1-937.3)], the development of new intracerebral focal changes early postinjury [p < 0.05, OR 24.1(1.0-559.1)], a decrease in white matter [p < 0.01, OR 33 (1.37-793.4)] and the development of severe atrophy before 3 months postinjury [p < 0.05, OR 24 (11.0-559.1)] were significantly correlated with a poor neurodevelopmental outcome.


CONCLUSIONS
Early clinical and radiological findings in ITBI are of prognostic value for neurodevelopmental outcome.
Ilves
Pilvi
P
Radiology Clinic, Tartu University Hospital, Tartu, Estonia. pilvi.ilves@kliinikum.ee
Lintrop
Mare
M
Talvik
Inga
I
Sisko
Annika
A
Talvik
Tiina
T
D001930:Brain Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000534:rehabilitation; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000401:mortality / Q000534:rehabilitation; D002675:Child, Preschool; D004185:Disability Evaluation; D004957:Estonia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D038642:Shaken Baby Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000534:rehabilitation; D014057:Tomography, X-Ray Computed