Much of the emphasis in treating pediatric TBI patients has been on reducing secondary insult through the use of intracranial pressure (ICP) monitoring and osmolar therapy, but this may not be enough. A retrospective analysis from the University of Pittsburgh team reported a 50% incidence of unfavorable outcome among 22 infants with severe TBI, despite nearly 900 hourly ICP readings in a PICU with rigorous ICP control and an excellent 8.6% severe TBI mortality rate (Dev. Neurosci. 2010;32:413-9).
"In many cases, we may need to identify other therapeutic targets," he said, adding that axonal injury may offer a temporally friendly therapeutic target in both TBI and abusive head trauma.
Finally, Dr. Kochanek suggested that abusive head trauma should be established as a separate entity from accidental TBI. He pointed out that the biomarker study, cited above, also found that patients with abusive head trauma demonstrate considerable delayed neuronal death, mirroring HIE more than TBI.
"Abusive head trauma is a separate entity and deserves its own therapeutic targets," he said.
Dr. Kochanek reported funding from the U.S. Army, the National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, the Defense Advanced Research Projects Agency, the Laerdal Foundation for Acute Medicine, and the American Heart Association.