Imaging Common Data Elements as Predictors of Long-Term Outcome in Pediatric TBI Traumatic brain injury (TBI) is the most common cause of acquired brain injury, mortality, and disability in children and adolescents, with long-term effect on cognition, academic achievement, psychosocial adjustment, and quality of life. Despite the high incidence of TBI in children and youth, there are few prognostic models using acute injury characteristics that are specific to children, and those that do exist have relatively poor accuracy. The proposed project builds on our group's ongoing study entitled """"""""Characterizing the Short and Long Term Consequences of Traumatic Brain Injury (TBI) Among Children in the United States"""""""" funded by the Centers for Disease Control and Prevention (CDC), which is a large, multi-site, prospective, longitudinal study to examine factors contributing to recovery patterns in children with complicated mild, moderate and severe pediatric TBI. In the existing study, a total of 500 children aged 8-18 years who are hospitalized for complicated mild (as defined by Glasgow Coma Scale (GCS) score of 13-15 with the presence of abnormal findings on imaging) and moderate-severe closed (non-penetrating) TBI will be recruited and assessed serially at 6-7 time points (baseline functioning, acute care discharge, rehabilitation discharge (f applicable), and 6, 12, 24 and 36 months after injury) using select outcome measures from the International Common Data Elements (CDEs) for TBI. The proposed study involves the additional parallel collection and analysis of acute clinical imaging from this cohort and will utilize the existing infrastructure of the parent study to leverage costs associated with participat recruitment, and collection of demographic, injury, and outcome data which will be used in conjunction with the imaging data. The imaging data from all project sites in the parent study will undergo centralized analysis by a pediatric neuroradiologist to derive Federal Interagency Traumatic Brain Injury Research (FITBIR)-compatible, comprehensive neuroimaging CDEs for TBI, including Basic and Supplemental level items, which code the presence, location and extent of pathology evident on imaging.
Specific Aim 1 involves the identification of the neuroimaging CDEs for TBI (based on standard of care initial CT imaging) most predictive of functional outcome in children with complicated mild to severe TBI.
Specific Aim 2 involves the assessment of whether CT-derived radiographic variables improve the prediction of long- term outcome in conjunction with a combination of other CDE-consistent acute demographic, physiological, and clinical neurological status variables as compared to either clinical indicators or imaging alone.
Specific Aim 3 involves determination of the relative sensitivity of initial CT findings versus subsequent scans performed in the first week in predicting later outcome for participants in whom multiple CT scans are performed.The information gained from this study will inform future research and clinical practice by identification of pathoanatomic features evident on imaging that, in combination with other demographic and clinical indicators, enhance prognosis following pediatric TBI.

Public Health Relevance

Brain imaging is often performed in individuals just after traumatic brain injury (TBI) to make important immediate clinical treatment decisions, but whether findings from clinical imaging can accurately predict long- term outcome in children with TBI is not well understood. This study builds upon an ongoing, large, multi-site study of long-term effects of pediatric TBI to collect and analyze patients'imaging data using a recently- established and standardized set of measures called the International Common Data Elements. This study will determine which subset of these measures is most predictive of recovery at one year post-injury, and whether imaging data alone or in combination with other acute clinical data can improve recovery prediction.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Research Grants (R03)
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Pediatrics Subcommittee (CHHD)
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Maholmes, Valerie
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Baylor College of Medicine
Physical Medicine & Rehab
Schools of Medicine
United States
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