Advisory Committee Chair
Sigrid Ladores
Advisory Committee Members
Michele Kong
Peng Li
Karin Reuter-Rice
Tedra Smith
Document Type
Dissertation
Date of Award
2021
Degree Name by School
Doctor of Philosophy (PhD) School of Nursing
Abstract
A traumatic brain injury (TBI) is a disruption of the normal function and structure of the brain after a direct or indirect injury. In children, TBI continues to be a significant cause of mortality resulting in the death of over 20 children per day in the United States (Reuter-Rice et al., 2015). Additionally, children who survive TBI have increased rates developmental delay, physical disabilities, neurologic impairment, and mental health disorders (Barlow et al., 2005). A TBI occurs in two phases. The primary injury is the physical insult to the brain that occurs at the time of the injury. The secondary injury phase is the resulting and ongoing pathophysiologic changes such as metabolic dysregulation and neuroinflammation (Araki et al., 2017). It is this ongoing secondary injury that contributes to the significant morbidity and mortality through continued brain damage (Deines et al., 2018). To reduce the severity of the secondary injury, understanding the pathophysiologic changes and effectiveness of interventions is needed. Corticosteroids are anti-inflammatory medications that could potentially mitigate ongoing secondary injury by reducing cerebral edema. However, current practice recommendations note the lack of evidence for its use in pediatric TBI (Kochanek et al., 2019). A conceptual analysis is presented to determine our current understanding of the role of corticosteroids in pediatric TBI. Transcranial Doppler ultrasound (TCD) is a noninvasive neuromonitor that measures cerebral hemodynamics. Although TCD has been iv used in pediatric sickle cell disease and neonatal intraventricular hemorrhage, its use in pediatric TBI is still in its infancy. Pulsatility index (PI), obtained by TCD, is a measurement of the distal peripheral resistance of the cerebral vasculature (O’Brien et al., 2018). Analysis of serial PI measurements in children with TBI is presented with evidence of its utility in TBI diagnosis and prognostication. Specifically, the change in PI is evaluated for its potential use as a biomarker in the management of TBI. Through a three manuscript format, this dissertation advances the current understanding of corticosteroid use and TCD in pediatric TBI by evaluating the changes in cerebral blood flow during the secondary injury phase and evaluating the current understanding of corticosteroid use.
Recommended Citation
Jordan, Jeremy D., "Implications of Day-to-Day Oulsatility Index Change and Corticosteroid use in Pediatric Traumatic Brain Injury" (2021). All ETDs from UAB. 624.
https://digitalcommons.library.uab.edu/etd-collection/624