MRI Markers of Outcome After Severe Pediatric TBI
Condition: Brain Injuries
MeSH terms: Brain Injuries
Study type: Observational

Summary: 
      Traumatic brain injury (TBI) is the leading cause of death or disability in children. Each
      year in the United States, pediatric TBI results in an estimated 630,000 emergency room
      visits, 58,900 hospitalizations, and 7000 deaths. The incidence of long-term disability after
      severe TBI is high, with over 60% of children requiring educational or community based
      supportive services 12 months post-injury. Over 5,000 children require inpatient
      rehabilitation after TBI each year and an estimated 145,000 US children are currently living
      with disabilities after a severe TBI. Hospital costs for the acute treatment of children with
      TBI are estimated at ~$2.6 billion each year, while the gross annual costs accounting for
      long-term care and lost productivity approach $60 billion. Therefore, pediatric TBI is a
      major public health concern and new ways to diagnose and treat TBI are urgently needed.
    

Detailed description: 
      Severe pediatric TBI results in a range of neurocognitive and behavioral deficits with
      resultant impact on school performance, social functioning, and quality of life. Sixty
      percent of children suffer from long-term functional impairments after severe TBI, and more
      than 40% demonstrate deficits in multiple cognitive and psychological domains. Importantly, a
      recent meta-analysis revealed that rather than catching up to their peers in these domains,
      children with severe TBI fall further behind over time. These deficits in cognitive and
      emotional function have a major impact on the child's quality of life after a TBI. A large
      study recently reported that severe TBI patients demonstrated lower quality of life than
      children undergoing active treatment for cancer. Considerable variation exists in the
      severity of impairment within each cognitive domain from patient to patient, likely relating
      to the mechanism of injury, the type and location of lesion, patient age, and pre-morbid
      functioning among other factors. While clinical scales such as the Glasgow Coma Scale (GCS)
      are useful for assessing injury severity and may provide general prognostic information, they
      are insufficient to identify risk for specific cognitive deficits. Identifying predictors of
      impairment within specific domains would aid in directing rehabilitation strategies towards
      at-risk cognitive domains, thereby improving long-term function and quality of life.

      The investigators are partnering with an ongoing pediatric TBI trial (ADAPT Trial: Approaches
      and Decisions in Acute Pediatric TBI) and will also be enrolling past UW patients and healthy
      controls. Consistency in timing of follow-up scans, large sample size and access to the ADAPT
      Trial injury severity data and neuropsychological testing will give this study unprecedented
      power to assess the relationship between early MRI findings and subsequent atrophy, white
      matter injury, network connectivity changes and neurocognitive and behavioral impairments.
    

Intervention name(s): MRI Scans
Intervention type(s): Other
Observational model: Other
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        Pediatric patients who have experienced TBI and had an acute MRI scan and those who
        participate in the prospective phase and obtain a follow-up MRI. Healthy controls will also
        be enrolled.
      
Keywords: Pediatrics; Neuroimaging