Evidence map›Paper›PMID 38148435›Full record

ArticleNeurocritical care2024

Utility of Early Magnetic Resonance Imaging to Enhance Outcome Prediction in Critically Ill Children with Severe Traumatic Brain Injury.

Anna M Janas, Kristen R Miller, Nicholas V Stence, Jordan M Wyrwa, Christopher M Ruzas, Ricka Messer, Peter M Mourani, Ericka L Fink, Aline B Maddux

Abstract read
PubMed Publisher
In one paragraph

Article in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.2field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 6 citations in OpenAlex.

  1. Review
  2. Burden of Intracranial Hypertension and Patterns of Brain Injury on MRI: Secondary Analysis of the 2014-2017 "Approaches and Decisions for Acute Pediatric TBI" Study.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2025
    Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Anna M JanasSection of Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13121 E. 17th Avenue, Ed2S, MS8414, Aurora, CO, 80045, USA. anna.janas@cuanschutz.edu.ORCID 0000-0002-7924-4424
Kristen R MillerDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Nicholas V StenceSection of Neuroradiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA.
Jordan M WyrwaDepartment of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA.
Christopher M RuzasSection of Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13121 E. 17th Avenue, Ed2S, MS8414, Aurora, CO, 80045, USA.
Ricka MesserSection of Child Neurology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA.
Peter M MouraniSection of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
Ericka L FinkDepartment of Critical Care Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Aline B MadduxSection of Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13121 E. 17th Avenue, Ed2S, MS8414, Aurora, CO, 80045, USA.
Children's Hospital Colorado · USUniversity of Colorado Denver · USArkansas Children's Hospital · USUniversity of Pittsburgh · US

Funding

Functional Outcomes after Prolonged Mechanical Ventilation in ChildrenK23HD096018 · NICHD · UNIVERSITY OF COLORADO DENVER · PI MADDUX, ALINE BERNARD · 2019 to 2023
$807k
NICHD NIH HHS K23 HD096018
6 · The paper itself

Abstract

backgroundMany children with severe traumatic brain injury (TBI) receive magnetic resonance imaging (MRI) during hospitalization. There are insufficient data on how different patterns of injury on early MRI inform outcomes.

methodsChildren (3-17 years) admitted in 2010-2021 for severe TBI (Glasgow Coma Scale [GCS] score < 9) were identified using our site's trauma registry. We used multivariable modeling to determine whether the hemorrhagic diffuse axonal injury (DAI) grade and the number of regions with restricted diffusion (subcortical white matter, corpus callosum, deep gray matter, and brainstem) on MRI obtained within 7 days of injury were independently associated with time to follow commands and with Functional Independence Measure for Children (WeeFIM) scores at the time of discharge from inpatient rehabilitation. We controlled for the clinical variables age, preadmission cardiopulmonary resuscitation, pupil reactivity, motor GCS score, and fever (> 38 °C) in the first 12 h.

resultsOf 260 patients, 136 (52%) underwent MRI within 7 days of injury at a median of 3 days (interquartile range [IQR] 2-4). Patients with early MRI were a median age of 11 years (IQR 7-14), 8 (6%) patients received cardiopulmonary resuscitation, 19 (14%) patients had bilateral unreactive pupils, the median motor GCS score was 1 (IQR 1-4), and 82 (60%) patients had fever. Grade 3 DAI was present in 46 (34%) patients, and restricted diffusion was noted in the corpus callosum in 75 (55%) patients, deep gray matter in 29 (21%) patients, subcortical white matter in 23 (17%) patients, and the brainstem in 20 (15%) patients. After controlling for clinical variables, an increased number of regions with restricted diffusion, but not hemorrhagic DAI grade, was independently associated with longer time to follow commands (hazard ratio 0.68, 95% confidence interval 0.53-0.89) and worse WeeFIM scores (estimate β - 4.67, 95% confidence interval - 8.33 to - 1.01).

conclusionsRegional restricted diffusion on early MRI is independently associated with short-term outcomes in children with severe TBI. Multicenter cohort studies are needed to validate these findings and elucidate the association of early MRI features with long-term outcomes in children with severe TBI.

Indexed as

Brain Injuries, TraumaticCritical IllnessMagnetic Resonance ImagingAdolescentChildChild, PreschoolCorpus CallosumDiffuse Axonal InjuryFemaleGlasgow Coma ScaleHumansMaleOutcome Assessment, Health CarePrognosisRegistriesWhite MatterMagnetic resonance imagingNeuroimagingOutcome predictionPediatric neurocritical careTraumatic brain injury

Identifiers

PMID38148435
OpenAlexW4390224823

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.