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


CONCLUSIONS
Results demonstrate that low PbtO2 may be prognostic of not only mortality but also neuropsychological outcomes.
ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa. leigh.schrieff-elson@uct.ac.za.
L E
LE
Schrieff-Elson
ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
K G F
KG
Thomas
Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
U K
UK
Rohlwink
Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
A A
AA
Figaji
D000293:Adolescent; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000150:complications* / Q000473:pathology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007360:Intelligence; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D009483:Neuropsychological Tests; D010100:Oxygen / Q000378:metabolism*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D010100:Oxygen
Brain injuries, traumatic; Brain oxygenation; Child; Neuropsychology; Neurosurgery