ORTH 3137 - Examen Final - Module 7 Flashcards
Module 7
Pediatric Traumatic Brain Injury
Pediatric Traumatic Brain Injury
- TBI (traumatic brain injury) is a leading cause of death and disability among children ages 1 to 19
- Each year, approximately 40% of TBIs in the United States occur in the pediatric population (ages 0 to 19)
- Higher rates of TBI in MALES
- Leading cuases of BTI in the pediatric population = FALLS and MOTOR VEHICLE-RELATED EVENTS
- Other common cause is being struck by/against a person or object (ex: at a sporting event)
PTBI - Commonly Examined Postconcussive Symptoms
Physical
- Headache
- Fatigue
- Balance problems/dizziness
- Nausea or vomiting
- Light of noise sensitivity
- Sleep disturbance
PTBI - Commonly Examined Postconcussive Symptoms
Cognitive
- Poor concentration
- Forgetfulness
- Mental slowing
- Fogginess
PTBI - Commonly Examined Postconcussive Symptoms
Emotional/Behavioural
- Sadness
- Nervousness
- Irritability
- Lack of initation
- Personality change
PTBI - Causes
Infants
- Mishandling by caregivers (accidental dropping, rolling from changing tables, physical abuse)
Toddlers:
- Falls, MVA, Physical abuse
Preschoolers:
- Falls, MVA, Physical abuse
Elementary school children:
- MVA, bicycle accidents, falls, injuries during play
Adolescents:
- MVA (including alcohol or drug misuse), sports injuries, assault, risk-taking behaviours
PTBI - Introduction
- Evidence base for effective treatment, at both acute and more chronic stages or recovery post-TBI, is largely lacking, across medical, pharmacological, and behavioural domains
- An additional complication is that children who suffer TBI are not representative of healthy population, and are more likely to have pre-existing behavioural and learning problems as well as social disadvantage
- These factors may impact negatively on recovery, and confound our ability to determine which post-injury predated the injury
PTBI - Acquired Brain Inury (ABI)
More general term that includes all types of injury to the brain.
- Including both non-traumatic (anoxic, toxic) and traumatic injuries
PTBI - Head Injury
This injury involves damage to any part of the head. It is a broad term that encompasses injury from internal accidents such as stroke or external forces such as a blow to the head. Head injury can imply injuries to the face, scalp, skull or brain.
- May be open- or closed- head injuries
PTBI - Open Head Injury
Brain tissue is penetrated from the outside, as with an obvious wound to the head such as a gunshot wound or a crushing of the skull, the skin and bone of the skull are actually penetrated and the brain may be exposed; The injury tends to result in localized (focal) damage and somewhat predictable impairments.
PTBI - Closed Head Injury
There is no open wound to the head, with damage caused by a blunt blow to the head or an aceleration/deceleration of the brain within the skull; there is no actual lesion to the skin or skull, but there is still damage to the brain within the skull; the injury results in more diffuse brain damage with resultant variable and unpredictable consequences.
PTBI - Traumatic Brain Injury (Definition)
- Type of acquired brain injury (ABI)
- Is the results of an external blow to the head
- TBI generally results in diffuse axonal injury secondary to acceleration forces
- This means there can be widespread damage within the cortex that can impair any variety of brain functions in unusual pattersn
PTBI - Primary Injury Mechanisms
Damage at the time of the injury
- Coup vs Contrecoup vs. Coup-contrecoup
- Damage can be localised (or focal) to the point of impact (coup)
- A second focal injury (contrecoup) can occur as teh brain bounces from the point of impact to the opposite side of the skull - Focal Contusions
- Portions of the prefrontal lobes and anterior and posterior temporal lobes are in close proximity to the bony prominences of the skulls
- When the brain is accelerated rapidly enough, it can be pushed into these bony protuberances; bruising and an increase of blood or fluid can be seen
- Diffuse axonal shearing damage also can be widespread (diffuse)
Tables 1-1 and 1-2
PTBI - Secondary Mechanisms
Complications after initial injury
- Oedema: swelling occurs at the time of injury and can continue for some time afterward. In closed-head injuries, there is no room for swelling tissue to expand beyond the cranium, resulting in an increase in intracranial pressure that can contribuet to a decline in consciousness. Treatment usually includes medication to reduce swelling and occasionally surgery to remove a portion of the skull or brain to alleviate the pressure of the swelling brain against the skull.
- Hypoxia: Abnormally low amounts of oxygen are supplied to the brain. This is particularly of concern to areas of the brain such as the hippocampus (memory), basil gnaglia (movement), and end arterial supply areas of the cerebral cortex and cerebellum (feeding the cortex).
- Hemorrhage or hematoma: As a result of the contusion or bruising process, bleeding or developement of blood clots continue to be a concern. Any disruption of the cerebral blood flow or its regulation can contribute to additional brain damage.
- Seizures: Seizure activity after injury is a possible complication. Often, children/adolescents are placed on medication as a preventative measure.
PTBI - Glasgow Coma Scale
- Scale employed in acute care facilities to determine level of consciousness and is a tool for localizing neurologic findings.
- Allows medical professionals to observe a patient throughout the first 48 hours in which the injury has occurred and assign levels of responsiveness in three areas:
1/ Eye opening
2/ Motor response
3/ Verbal response - The patient’s GCS score helps determine the severity of the TBI:
- Severe TBI = 3-8
- Moderate TBI = 9-12
- Mild TBI = 13-15