Medical Student Research Fellowship for Summer 2011
Mentor: Darryl Miles, M.D.
Room number: C11.304
Mail Code: 9063
Phone number: (214) 456-7969
Project title: A Quantitative CT Analysis of Intracranial Hematoma Expansion After Traumatic Brain Injury in Children
Human subjects IRB approved project number: 012005-010
Animal subjects IRB approved project number: (N/A)
Project Type: patient-based research
Brief Description of Project: Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in children over the age of 1. Children who suffer moderate and severe TBI are often left with permanent sequelae resulting in lifelong disabilities affecting the individual, their family and society as a whole.
Computed tomography (CT) is integral in the early diagnosis and management of traumatic brain injury and of intracranial hematomas. Although the benefits associated with the initial CT scan outweigh the risks in head injured patients, estimates have found that lifetime radiation risks for children undergoing CT are not negligible due to the rapidly increasing utilization of pediatric CT exams. Thus, evidence based practice to support safe and judicious use of head CT scans in children after TBI may reduce this risk. This study primary aim is to quantitatively characterize the temporal profile of intracranial hematoma progression in pediatric patients after pediatric brain injury.
Patients will be selected from a separate prospective cohort of children with moderate and severe TBI at Children’s Medical Center Dallas, we have prospectively collected data on injury severity, hospital course and neuropsychological outcome measures in over 150 children. All patients included in the study were of the ages 0 to 13 years with a traumatic brain injury and a history of trauma resulting in either an epidural, subdural, and/or intracranial hematoma. Patients with spontaneous intracerebral hemorrhages or non-accidental trauma will be excluded. The patients are required to have initial head CT scans and a repeat CT scan within 48-72 hours from the initial scan. In the cases in which the patients underwent surgical intervention, the repeat CT prior to surgical treatment will be used.
The official radiology reading will be used to confirmed the diagnosis of intracranial hemorrhage and the volume of the initial hematoma was determined using the ABC/2 method outlined by Kothari et al. and recorded. This procedure was repeated during the review of the follow up CT obtained within 48 hrs following the initial CT to determine the final volume of the hematoma. The initial and repeat CT scans will be compared to determine the percent change or hematoma progression. Hematoma progression was considered significant if the volume percent change was greater than 33%. The value of 33% was chosen because a volume change of 33% is equivalent to a 10% diameter change, which is discernible by the naked eye on a CT. Clinical significance will also be determined by measuring the correlation between the hematoma volume percent change and the following indicators of patient status: the change in the Glasgow Coma Scale, the need for surgical intervention (either decompressive craniectomy or hematoma evacuation craniotomy), and patient outcome using mortality data or functional outcome assessments.
Based on knowledge of the rate and temporal profile of progression of hematomas in pediatric patients, it can be determined how frequently repeat CT scans need to be done. Through more effective and sparing use of CT scans, CT ionization risk in children can be reduced.