Pediatric traumatic brain injury (TBI) is a major cause of death and disability. While the damage caused by the primary injury may not be alterable by treatment, the effects of the secondary injury—subsequent metabolic, humoral and cellular derangements—can be modified. By ensuring good hemodynamics, gas exchange and intracranial pressure control, physicians can improve outcomes. However, the appearance of vasospasm and subsequent ischemia has been demonstrated in up to 45% of adults with TBI (depending on the criteria used to define vasospasm) and has been associated with worse outcomes. In a recent study, O’Brien et al sought to evaluate the prevalence, time to onset and duration of vasospasm in children with moderate to severe TBI. For their single center, prospective, observational study, the authors enrolled 69 children with TBI (35 subjects had moderate TBI and 34 had severe TBI).
They found that vasospasm occurs in a sizeable number of children with moderate and severe TBI. However, while the authors recommend “aggressive screening” for posttraumatic vasospasm in these patients, appropriate therapies have not been described in any studies. Clearly, future studies should be done to measure long-term outcomes and responses to specific therapies.
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