• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Master's Dissertation
DOI
10.11606/D.17.2017.tde-10012017-094159
Document
Author
Full name
Daniele da Silva Jordan Volpe
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2016
Supervisor
Committee
Carlotti, Ana Paula de Carvalho Panzeri (President)
Fioretto, José Roberto
Santos, Antonio Carlos dos
Title in Portuguese
Avaliação do desfecho neuropsicológico de crianças vítimas de traumatismo cranioencefálico e sua correlação com a gravidade do quadro, o tratamento na unidade de terapia intensiva e os achados tardios de ressonância magnética de encéfalo
Keywords in Portuguese
Crianças
Desfecho
Ressonância Magnética
Traumatismo cranioencefálico
Abstract in Portuguese
O traumatismo cranioencefálico é a principal causa de retardo de desenvolvimento neuropsicomotor adquirido na infância. O presente estudo tem por objetivo avaliar o desfecho neuropsicológico de longo prazo após TCE e sua associação com a gravidade do trauma, o tratamento instituído na Unidade de Terapia Intensiva e os achados tardios de ressonância magnética. Trata-se de estudo de coorte de todas as crianças e adolescentes vítimas de TCE, internadas na Unidade de Terapia Intensiva Pediátrica da Unidade de Emergência do HC-FMRP no período de 1 janeiro de 2007 a 31 de dezembro de 2011, com idade entre 6 e 16 anos no momento da avaliação. A gravidade inicial do quadro foi avaliada pela análise dos prontuários; a avaliação neurológica pela Glasgow Outcome Scale (GOS), Extended Glasgow Outcome Scale (GOSe) e King's Outcome Scale for Childhood Head Injury (KOSCHI), a avaliação neuropsicológica pela escala Wechsler de Inteligência para Crianças 4ª edição (WISC IV) e, por fim, exame de ressonância magnética. Foram selecionadas 25 crianças, cuja idade variou de 1 a 12 anos (mediana = 6 anos) no momento do trauma, e de 6 a 15 anos no momento da avaliação (mediana = 12 anos). Segundo a 4 gravidade, 12 pacientes tiveram TCE Grave ( 48%), 4 TCE Moderado (16%) e 9 TCE Leve (36%). O tempo de internação no CTIP variou de 1 a 21 dias (mediana = 4 dias). As causas mais comuns de trauma foram atropelamentos (36%), quedas (16%) e acidentes com carro ou moto (24%). Os pacientes foram divididos em grupo Sequela (SE) e grupo Boa Recuperação (BR), segundo a avaliação neurológica. O grupo SE apresentou menores valores dos índices psicométricos (índice de Memória Operacional (IMO), índice de organização perceptual (IOP), índice de compreensão verbal (ICV) e índice de velocidade de processamento (IVP) e quociente de inteligência total (QIT)) avaliados pelo WISC IV. Não houve associação dos achados de TC de crânio com o desfecho neuropsicológico. Dentre os pacientes do grupo BR, 60% apresentaram exame de ressonância magnética dentro da normalidade ou com alterações mínimas enquanto no grupo SE, 90% dos pacientes apresentaram exames com alterações graves. As escalas de desfecho para avaliação neurológica pós TCE mostraram-se eficazes em detectar os pacientes com alteração cognitiva e RM alterada, sendo um bom método de screening no seguimento destes pacientes.
Title in English
Evaluation of neuropsychological outcome of children victims of traumatic brain injury and its correlation with trauma severity, treatment at the intensive care unit and late findings of magnetic resonance imaging
Keywords in English
Children
Magnetic resonance
Outcome
Traumatic barin injury
Abstract in English
Traumatic brain injury (TBI) is the main cause of neurodevelopmental delay acquired in childhood. This study aimed to evaluate long-term neuropsychological outcome after TBI and its association with trauma severity, treatment provided in the pediatric intensive care unit (PICU) and late magnetic resonance imaging (MRI) findings. It was a cohort study of all children and adolescents victims of TBI admitted to the PICU of Hospital das Clínicas of Ribeirão Preto Medical School, University of São Paulo from January 1st, 2007 to December 31st, 2011, who were aged 6-16 years at the time of the study. The severity of trauma was determined by analysis of medical records, neurological assessment was performed by Glasgow Outcome Scale (GOS), Extended Glasgow Outcome Scale (eGOS) and King's Outcome Scale for Childhood Head Injury (KOSCHI), neuropsychological assessment was performed by Wechsler Intelligence Scale for Children 4th Edition (WISC IV), and finally, patients underwent MRI.Twenty-five children aged 1-12 years (median 6 years) at the time of trauma were included. They were 6-15 years-old at the time of study evaluation (median = 12 years). Twelve (48%) patients had severe TBI, 4 (16%) had moderate TBI and 9 (36%) had mild TBI. Length of PICU stay ranged from 1 to 21 days (median = 4 days). The most common causes of trauma were pedestrians hit by vehicles (36%), falls (16%) and car or motorcycle accidents (24%). Patients were divided into Disability (DIS) and 6 Good Recovery (GR) groups, according to the neurological assessment. The DIS group showed lower values of psychometric indices, including working memory index (WMI), perceptual organization index (POI), verbal comprehension index (VCI), processing speed index (PSI), and total Intelligence Quotient (TIQ), as assessed by WISC IV.There was no association of CT scan findings with neuropsychological outcome. Sixty percent of patients in the GR group had MRI examination within the normal range or with minimal alterations while 90% of patients in the DIS group had severe MRI abnormalities. The outcome scales for neurological evaluation following TBI were effective in detecting patients with cognitive impairment and altered MRI, being a good screening method for patients' follow-up.
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
DANIELEVOLPE.pdf (2.02 Mbytes)
Publishing Date
2017-04-19
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2019. All rights reserved.