Vasospasm in children with traumatic brain

Abstract Objective: To determinethe incidence of vasospasm in chil-dren who have suffered moderate tosevere traumatic brain injury. Meth-ods: A prospective observationalpilot study in a 24-bed pediatricintensive care unit was performed.Twenty-two children aged 7 monthsto 14 years with moderate to severetraumatic brain injury as indicated byGlasgow Coma Score B12 andabnormal head imaging were enrol-led. Transcranial Doppler ultrasoundwas performed to identify and followvasospasm. Patients with a flowvelocity in the middle cerebral artery(MCA)[120 cm/s were consideredto have vasospasm by criterion A.If flow velocity in the MCA was[120 cm/s and the Lindegaard ratiowas[3, vasospasm was considered tobe present by criterion B. Patientswith basilar artery (BA) flow velocity[90 cm/s met criteria for vasospasmin the posterior circulation (criterionC). Results: In the MCA, 45.5% ofpatients developed vasospasm basedon criterion A and 36.3% developedvasospasm based on criterion B. Atotal of 18.2% of patients developedvasospasm in the BA by criterion C.Typical day of onset of vasospasmwas hospital day 2–3. Duration ofvasospasm in the anterior circulationwas 4 ± 2 days based on criteria Aand 3 ± 1 days based on criteria B.Vasospasm in the posterior circula-tion persisted for 2 ± 1 days.Conclusions: Using the adult crite-ria outlined above to diagnosevasospasm, a significant proportion ofpediatric patients who have sufferedmoderate to severe traumatic braininjury develop vasospasm during thecourse of their treatment.Keywords Vasospasm Transcranial doppler ultrasound Traumatic brain injury Pediatric