Pediatric Traumatic Brain Injury
What is traumatic brain injury?
Traumatic brain injury (TBI) is damage to the brain caused by injury to the head.
Pediatric TBI is classified as either mild, moderate or severe. Most mild TBI patients recover well, while more severe TBI patients often have substantial, permanent disabilities or can even die as a result of the trauma.
In the United States, TBI is the primary cause of death in children younger than age 24 and the leading cause of disability in children. It affects 70 in 100,000 children, costing $1 billion in hospital charges annually.
(Schneier AJ, “Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States,” Pediatrics, 2006)
The long-term effects of TBI, which can be devastating, include headaches, memory loss, change in personality, developmental decline, seizures, weakness, numbness and vision loss.
What are the causes and symptoms of pediatric traumatic brain injury?
The major causes of pediatric TBI vary depending on the age of the child.
- Older teenagers are prone to motor vehicle accidents.
- Older children are most likely to experience sports-related injuries.
- Toddlers are most often injured in falls.
- Infants usually suffer from intentionally inflicted injuries.
(Keenan HT and Bratton SL, Epidemiology and outcomes of pediatric traumatic brain injury, Developmental Neuroscience, 2006)
How is pediatric traumatic brain injury diagnosed?
Many children with traumatic brain injury also have injuries to other body parts that also need quick treatment. A diagnosis of pediatric TBI is based on evaluation by a multidisciplinary trauma team, using a CT scan of the head completed as soon as possible after the injury. The physician may also order a brain MRI to examine more subtle aspects of brain structure and look for injury.
How is pediatric traumatic brain injury treated?
Mild and moderate TBI patients may not need medical or surgical therapies. Patients should be evaluated by physical, speech and occupational therapists and a pediatric neuropsychologist. This team will help individualize a school program based on the cognitive deficits the patient sustains after the TBI.
Severe TBI patients in a coma require invasive monitoring of intracranial pressure (ICP) with either a fiber-optic ICP monitor, a diagnostic procedure, or an external ventricular drain (EVD), which is both diagnostic and therapeutic. Patients with severe skull fractures or intracranial hemorrhage may require additional emergent neurosurgical procedures.
When the intracranial pressure is above normal, medications are used to help decrease the swelling of the brain. In some severe TBI cases, additional medications are used to slow down the metabolic rate of the brain to decrease the ICP.
When the elevated ICP cannot be controlled with medications alone, decompressive craniectomy surgery may be required. In this procedure, a large window of bone from the skull over the swollen, injured brain is removed and stored. The next step in the procedure is a duraplasty, during which the covering of the brain (the dura) is opened widely and a patch is placed to enlarge the space for the brain to swell. The skin is closed and the patient’s brain is allowed to swell over the course of the next few weeks, during which the patient needs extensive inpatient rehabilitation. Once the swelling is decreased sufficiently, the patient returns for open surgery, during which the stored bone or a new synthetic bone is replaced to fill the skull defect.
What follow-up treatment is necessary?
Pediatric TBI patients need follow-up with pediatric neurosurgeons, physical, speech and occupational therapists, as well as pediatric neuropsychology and potentially pediatric neurology specialists.
After Daniel Turya got a brand new bike for his eighth birthday, he hit the back of his head on the concrete after colliding with his friend. When a trip to the ER revealed a traumatic brain injury, the doctors at the Children's Memorial Hermann Hospital were called to help save his life.
Read Daniel's Story »
It was a February afternoon when 14-year-old Tyerike Cleveland set off on a bike ride that almost turned tragic when a driver in a truck ran a red light where Tyerike was crossing the street, hitting his bike and sending him flying and crashing hard in the middle of the street.
Read Tyerike's Story »
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