Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma.

BACKGROUND AND PURPOSE: MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma. MATERIALS AND METHODS: A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma. All patients received noncontrast head CT, ultrafast brain MR imaging without sedation, and standard MR imaging with general anesthesia or an immobilizer, sequentially. Two pediatric neuroradiologists independently reviewed each technique blinded to other modalities for intracranial trauma. We performed interreader agreement and consensus interpretation for standard MR imaging as the criterion standard. Diagnostic accuracy was calculated for ultrafast MR imaging, noncontrast head CT, and combined ultrafast MR imaging and noncontrast head CT. RESULTS: Interreader agreement was moderate for ultrafast MR imaging (κ = 0.42), substantial for noncontrast head CT (κ = 0.63), and nearly perfect for standard MR imaging (κ = 0.86). Forty-two percent of patients had discrepancies between ultrafast MR imaging and standard MR imaging, which included detection of subarachnoid hemorrhage and subdural hemorrhage. Sensitivity, specificity, and positive and negative predictive values were obtained for any traumatic pathology for each examination: ultrafast MR imaging (50%, 100%, 100%, 31%), noncontrast head CT (25%, 100%, 100%, 21%), and a combination of ultrafast MR imaging and noncontrast head CT (60%, 100%, 100%, 33%). Ultrafast MR imaging was more sensitive than noncontrast head CT for the detection of intraparenchymal hemorrhage (P = .03), and the combination of ultrafast MR imaging and noncontrast head CT was more sensitive than noncontrast head CT alone for intracranial trauma (P = .02). CONCLUSIONS: In abusive head trauma, ultrafast MR imaging, even combined with noncontrast head CT, demonstrated low sensitivity compared with standard MR imaging for intracranial traumatic pathology, which may limit its utility in this patient population.

Increased height in patients with medulloblastomas.

OBJECTIVE: Medulloblastomas demonstrate histological features similar to neuroendocrine tumors. Expression of various receptors for growth factors and production of growth hormones have been identified to occur with medulloblastomas. We studied the preoperative height of patients with medulloblastomas. METHODS: We studied 85 patients (64 children and 21 adults) with medulloblastomas and 42 patients (27 children and 15 adults) with cerebellar astrocytomas who served as a control group. All of the patients had their height and weight documented on standardized growth charts. In addition, age, sex, symptoms, radiographic findings, treatment, and survival were examined. RESULTS: Preoperatively, 22.4% of the patients with medulloblastomas were above the 95% curve in height and 80.0% were above the 50% curve for height. Compared with patients with cerebellar astrocytomas, 7.1% were above the 95% curve for height and 54.8% were above the 50% curve for height. The distribution of patients along the weight curves for both tumor types demonstrated a slight prevalence for lower weights but was not significantly different from the national average. A significant number of patients presenting with medulloblastomas attained increased height, which was disproportionate to the weight loss generally observed with neoplasms. To our knowledge, the disproportionate number of patients with medulloblastomas and increased height has not been reported before. A similar deviation in height distribution from the normal population could not be identified in patients with cerebellar astrocytomas. CONCLUSION: This study suggests that medulloblastomas may be influenced by growth hormone production or may produce growth factors in vivo.

Alteration in level of responsiveness. A proposed nursing diagnosis.

The use of physiologically derived nursing diagnoses is crucial in care delivery to the patient population at risk for secondary neurologic injury. Eliminating physiologic diagnoses has left the current taxonomic representation of nursing diagnoses inadequate for describing or quantifying care delivery to this patient population. The literature supports the premise that nursing care plays a large role in prevention and minimization of secondary brain injury. The proposed nursing diagnosis "alteration in level of responsiveness" recognizes the use of physiologic concepts and data and is an appropriate label to describe the nursing care provided to the patient at risk for secondary brain injury.

Interventions related to neurologic care.

Patient outcomes in the neuroscience patient population can be optimized by appropriate and timely selection of nursing actions and interventions. This study is contributing to the advancement of neuroscience nursing by identifying 13 intervention labels with more than 300 activities to be used in the planning and delivery of care of these patients. Implications for further research are multiple, including a need for clinical research regarding the appropriateness and effectiveness of the items as well as establishing the frequency with which these items occur in clinical practice.