Gray-white matter ratio in pediatric and adult cardiopulmonary arrest studies: a rapid review.

Kie Honjo, Geraldine Goco, Ahmed Al Khalifah, Nicole McKinnon, Barnaby R Scholefield, Suzanne Laughlin, Anne-Marie Guerguerian

Abstract readReview

PubMed Full text at PMC Publisher

In one paragraph

Review in Resuscitation plus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

7 authors.

Kie HonjoNeuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.

Geraldine GocoNeuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.

Ahmed Al KhalifahDepartment of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Nicole McKinnonDepartment of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Barnaby R ScholefieldDepartment of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Suzanne LaughlinDepartment of Diagnostic and Interventional Radiology, Division of Neuroradiology, The Hospital for Sick Children, Medical Imaging Department, University of Toronto, Toronto, ON, Canada.

Anne-Marie GuerguerianNeuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objectives: The gray-white matter ratio is used to estimate tissue edema on head computed tomography scans in cardiac arrest research. This rapid review aimed to determine whether gray-white matter ratio values differed between studies that included children and adults. We hypothesized that brain maturity affects myelination and, consequently, age would alter the range of the gray-white matter ratio. Methods: We searched PubMed from 2000 to 2025. Studies were selected if they included children or adult patients with cardiac arrest and reported gray-white matter ratio values relative to neurologic outcome groups or to normal controls. We summarized the studies and explored how gray-white matter values trended with age, gray-white matter ratio equations, timing of image acquisition during the post-resuscitation phase, and neurologic outcome groups. Results: We retrieved five studies in children and 40 in adults. Regions of interest and equations used to measure gray-white matter ratio varied between studies, but most included the basal ganglia. The gray-white matter ratio was generally lower in poor-outcome groups than in good-outcome groups. In children with good outcomes, gray-white matter ratio values were similar to those of adults with poor outcomes. The gray-white matter ratio values were lower in younger children than in older children and adults. We did not find a consistent relationship between gray-white matter ratio values and the elapsed time from cardiac arrest to image acquisition. Conclusions: This review revealed varying gray-white matter ratios between children and adults in cardiac arrest studies, underscoring the importance of accounting for age when evaluating gray-white matter ratios in pediatric cardiac arrest populations. Gray-white matter ratio values were dependent on the regions of interest included in the equations. Readers should be aware of these sources of variation when comparing studies that use the gray-white matter ratio as a biomarker of hypoxic-ischemic injury in cardiac arrest. Future work is warranted to optimize the use of the gray-white matter ratio in pediatric cardiac arrest research.

Indexed as

AdultsCardiac arrestGray-white matter ratioHead CTHypoxic-ischemic injuryOutcomePediatrics

Identifiers

PMID42080204

DOI10.1016/j.resplu.2026.101321

PMCPMC13129448

What OpenQuestion holds

Textmetadata

LicenceCC BY

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.