Diffuse axonal injury on magnetic resonance imaging and its relation to neurological outcomes in pediatric traumatic brain injury.

OBJECTIVE: Diffuse axonal injury (DAI), a frequent consequence of pediatric traumatic brain injury (TBI), presents challenges in predicting long-term recovery. This study investigates the relationship between the severity of DAI and neurological outcomes in children. METHODS: We conducted a retrospective analysis of 51 pediatric TBI patients diagnosed with DAI using Adam's classification. Neurological function was assessed at 2, 3, and 6 weeks, and 12 months post-injury using the Pediatric Glasgow Outcome Scale-Extended (PGOSE). RESULTS: PGOSE scores significantly improved over time across all DAI grades, suggesting substantial recovery potential even in initially severe cases. Despite indicating extensive injury, patients with DAI grades II and III demonstrated significant improvement, achieving a good recovery by 12 months. Although the initial Glasgow Coma Scale (GCS) score did not show a statistically significant association with long-term outcomes in our limited sample, these findings suggest that the severity of DAI alone may not fully predict eventual recovery. CONCLUSIONS: Our study highlights the potential for significant neurological recovery in pediatric patients with DAI, emphasizing the importance of long-term follow-up and individualized rehabilitation programs. Further research with larger cohorts and extended follow-up periods is crucial to refine our understanding of the complex relationships between DAI severity, injury mechanisms, and long-term neurological outcomes in children.

Feasibility of Wire-in-Needle Technique for Ultrasound-Guided Central Venous Catheter Insertion in a Pediatric ICU.

Objective For further evaluating the feasibility and safety of wire-in-needle (WIN) technique application for ultrasound-guided central venous catheter (USG-CVC) insertion in a pediatric intensive care unit (PICU). Methods We prospectively monitored all patients who underwent central line insertion guided by ultrasound from March 2018 to March 2019. An independent nurse recorded the patient's age, gender, weight and BMI, diagnosis, indication for insertion, blood pressure state, insertion time, line size, number of pricks, and arterial punctures. Results A central line was inserted in 141 patients. The author applied the WIN technique in 16 patients, while in 125 patients, the central line was inserted via the traditional technique. The success rate was 100% for the WIN technique arm with zero arterial pricks, and the mean number of needle pricks was 1.1. For the traditional technique arm, the success rate was 90% with three arterial pricks. The mean number of needle pricks was 1.38. The insertion time was 86.25 seconds and 304 seconds for the WIN technique and the standard technique, respectively; this difference was statistically significant (p <0.001). Conclusion The WIN technique is feasible and could provide a safe and relatively fast alternative technique for real-time USG-CVC insertion in the PICU. The WIN technique is feasible and not inferior to the standard short-axis technique. A good level of experience related to USG-CVC insertion provides a safe and rapid alternative technique for real-time USG-CVC insertion in the PICU.