{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:42:22Z","timestamp":1783111342771,"version":"3.54.6"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Pediatric traumatic subarachnoid hemorrhage (tSAH) often results in intensive care unit (ICU) admission, the performance of additional diagnostic studies, and ICU-level therapeutic interventions to identify and prevent episodes of neuroworsening.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Data prospectively collected in an institutionally specific trauma registry between 2006 and 2015 were supplemented with a retrospective chart review of children admitted with isolated traumatic subarachnoid hemorrhage (tSAH) and an admission Glasgow Coma Scale (GCS) score of 13\u201315. Risk of blunt cerebrovascular injury (BCVI) was calculated using the BCVI clinical prediction score.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Three hundred seventeen of 10,395 pediatric trauma patients were admitted with tSAH. Of the 317 patients with tSAH, 51 children (16%, 23 female, 28 male) were identified with isolated tSAH without midline shift on neuroimaging and a GCS score of 13\u201315 at presentation. The median patient age was 4 years (range 18 days to 15 years). Seven had modified Fisher grade 3 tSAH; the remainder had grade 1 tSAH. Twenty-six patients (51%) had associated skull fractures; 4 involved the petrous temporal bone and 1 the carotid canal. Thirty-nine (76.5%) were admitted to the ICU and 12 (23.5%) to the surgical ward. Four had an elevated BCVI score. Eight underwent CT angiography; no vascular injuries were identified. Nine patients received an imaging-associated general anesthetic. Five received hypertonic saline in the ICU. Patients with a modified Fisher grade 1 tSAH had a significantly shorter ICU stay as compared to modified Fisher grade 3 tSAH (1.1 vs 2.5 days, p = 0.029). Neuroworsening was not observed in any child.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Children with isolated tSAH without midline shift and a GCS score of 13\u201315 at presentation appear to have minimal risk of neuroworsening despite the findings in some children of skull fractures, elevated modified Fisher grade, and elevated BCVI score. In this subgroup of children with tSAH, routine ICU-level care and additional diagnostic imaging may not be necessary for all patients. Children with modified Fisher grade 1 tSAH may be particularly unlikely to require ICU-level admission. Benefits to identifying a subgroup of children at low risk of neuroworsening include improvement in healthcare efficiency as well as decreased utilization of unnecessary and potentially morbid interventions, including exposure to ionizing radiation and general anesthesia.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.5.peds18140","type":"journal-article","created":{"date-parts":[[2018,8,10]],"date-time":"2018-08-10T13:55:40Z","timestamp":1533909340000},"page":"559-566","source":"Crossref","is-referenced-by-count":10,"title":["The identification of a subgroup of children with traumatic subarachnoid hemorrhage at low risk of neuroworsening"],"prefix":"10.3171","volume":"22","author":[{"given":"Cecilia L.","family":"Dalle Ore","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Rennert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J.","family":"Schupper","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon C.","family":"Gabel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"},{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Peterson","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care, Rady Children\u2019s Hospital, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence F.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"},{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hal S.","family":"Meltzer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine; and"},{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1097\/TA.0000000000000662","article-title":"Basal skull fractures are associated with mortality in pediatric severe traumatic brain injury","volume":"78","author":"Alhelali I","year":"2015","unstructured":"Alhelali I, Stewart TC, Foster J, Alharfi IM, Ranger A, Daoud H, : Basal skull fractures are associated with mortality in pediatric severe traumatic brain injury. J Trauma Acute Care Surg 78:1155\u20131161, 201510.1097\/TA.000000000000066226151517"},{"key":"b2","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1007\/s12028-016-0303-5","article-title":"Derivation of a predictive score for hemorrhagic progression of cerebral contusions in moderate and severe traumatic brain injury","volume":"26","author":"Allison RZ","year":"2017","unstructured":"Allison RZ, Nakagawa K, Hayashi M, Donovan DJ, Koenig MA: Derivation of a predictive score for hemorrhagic progression of cerebral contusions in moderate and severe traumatic brain injury. Neurocrit Care 26:80\u201386, 201710.1007\/s12028-016-0303-527473209"},{"key":"b3","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"668","DOI":"10.3171\/2017.2.PEDS16419","article-title":"Medical necessity of routine admission of children with mild traumatic brain injury to the intensive care unit","volume":"19","author":"Ament JD","year":"2017","unstructured":"Ament JD, Greenan KN, Tertulien P, Galante JM, Nishijima DK, Zwienenberg M: Medical necessity of routine admission of children with mild traumatic brain injury to the intensive care unit. J Neurosurg Pediatr 19:668\u2013674, 20172838764410.3171\/2017.2.PEDS16419"},{"key":"b4","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1179\/016164106X115053","article-title":"Traumatic subarachnoid hemorrhage: our current understanding and its evolution over the past half century","volume":"28","author":"Armin SS","year":"2006","unstructured":"Armin SS, Colohan AR, Zhang JH: Traumatic subarachnoid hemorrhage: our current understanding and its evolution over the past half century. Neurol Res 28:445\u2013452, 200610.1179\/016164106X11505316759448"},{"key":"b5","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1097\/TA.0b013e318054e25a","article-title":"Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury","volume":"62","author":"Brown CV","year":"2007","unstructured":"Brown CV, Zada G, Salim A, Inaba K, Kasotakis G, Hadjizacharia P, : Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury. J Trauma 62:1339\u20131345, 200710.1097\/TA.0b013e318054e25a17563645"},{"key":"b6","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1097\/00005373-199906000-00030","article-title":"Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event","volume":"46","author":"Carrillo EH","year":"1999","unstructured":"Carrillo EH, Osborne DL, Spain DA, Miller FB, Senler SO, Richardson JD: Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event. J Trauma 46:1120\u20131125, 199910.1097\/00005373-199906000-0003010372637"},{"key":"b7","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1227\/01.NEU.0000156200.76331.7A","article-title":"Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients","volume":"56","author":"Chieregato A","year":"2005","unstructured":"Chieregato A, Fainardi E, Morselli-Labate AM, Antonelli V, Compagnone C, Targa L, : Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery 56:671\u2013680, 20051579250510.1227\/01.NEU.0000156200.76331.7A"},{"key":"b8","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1227\/01.NEU.0000340796.18738.F7","article-title":"Patients with moderate head injury: a prospective multicenter study of 315 patients","volume":"64","author":"Compagnone C","year":"2009","unstructured":"Compagnone C, d\u2019Avella D, Servadei F, Angileri FF, Brambilla G, Conti C, : Patients with moderate head injury: a prospective multicenter study of 315 patients. Neurosurgery 64:690\u2013697, 20091919722010.1227\/01.NEU.0000340796.18738.F7"},{"key":"b9","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1097\/CCM.0b013e31823c8d03","article-title":"A comparison of critical care research funding and the financial burden of critical illness in the United States","volume":"40","author":"Coopersmith CM","year":"2012","unstructured":"Coopersmith CM, Wunsch H, Fink MP, Linde-Zwirble WT, Olsen KM, Sommers MS, : A comparison of critical care research funding and the financial burden of critical illness in the United States. Crit Care Med 40:1072\u20131079, 20122220271210.1097\/CCM.0b013e31823c8d03"},{"key":"b10","series-title":"J Head Trauma Rehabil","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/HTR.0b013e31825e19e5","article-title":"Does isolated traumatic subarachnoid hemorrhage affect outcome in patients with mild traumatic brain injury?","volume":"28","author":"Deepika A","year":"2013","unstructured":"Deepika A, Munivenkatappa A, Devi BI, Shukla D: Does isolated traumatic subarachnoid hemorrhage affect outcome in patients with mild traumatic brain injury? J Head Trauma Rehabil 28:442\u2013445, 20132283237210.1097\/HTR.0b013e31825e19e5"},{"key":"b11","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"649","DOI":"10.3171\/2014.10.JNS132713","article-title":"The nonsurgical nature of patients with subarachnoid or intraparenchymal hemorrhage associated with mild traumatic brain injury","volume":"123","author":"Ditty BJ","year":"2015","unstructured":"Ditty BJ, Omar NB, Foreman PM, Patel DM, Pritchard PR, Okor MO: The nonsurgical nature of patients with subarachnoid or intraparenchymal hemorrhage associated with mild traumatic brain injury. J Neurosurg 123:649\u2013653, 20152552627010.3171\/2014.10.JNS132713"},{"issue":"5 Suppl","key":"b12","series-title":"J Neurosurg","first-page":"365","article-title":"Utility of serial computed tomography imaging in pediatric patients with head trauma","volume":"105","author":"Durham SR","year":"2006","unstructured":"Durham SR, Liu KC, Selden NR: Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg 105 (5 Suppl):365\u2013369, 200617328259"},{"key":"b13","series-title":"Acad Emerg Med","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/j.1553-2712.2011.01285.x","article-title":"Emergency department neurologic deterioration in patients with spontaneous intracerebral hemorrhage: incidence, predictors, and prognostic significance","volume":"19","author":"Fan JS","year":"2012","unstructured":"Fan JS, Huang HH, Chen YC, Yen DH, Kao WF, Huang MS, : Emergency department neurologic deterioration in patients with spontaneous intracerebral hemorrhage: incidence, predictors, and prognostic significance. Acad Emerg Med 19:133\u2013138, 20122232036310.1111\/j.1553-2712.2011.01285.x"},{"key":"b14","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1227\/01.NEU.0000218821.34014.1B","article-title":"Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified Fisher scale","volume":"59","author":"Frontera JA","year":"2006","unstructured":"Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr, : Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified Fisher scale. Neurosurgery 59:21\u201327, 20061682329610.1227\/01.NEU.0000218821.34014.1B"},{"key":"b15","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.wneu.2017.01.046","article-title":"Triage patterns of traumatic subarachnoid hemorrhage: is referral to a tertiary care center necessary?","volume":"100","author":"Gates M","year":"2017","unstructured":"Gates M, Mallory G, Planchard R, Nothdurft G, Graffeo C, Atkinson J: Triage patterns of traumatic subarachnoid hemorrhage: is referral to a tertiary care center necessary? World Neurosurg 100:417\u2013423, 20172813016610.1016\/j.wneu.2017.01.046"},{"key":"b16","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"445","DOI":"10.3171\/jns.1995.83.3.0445","article-title":"Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part I: A proposed computerized tomography grading scale","volume":"83","author":"Greene KA","year":"1995","unstructured":"Greene KA, Marciano FF, Johnson BA, Jacobowitz R, Spetzler RF, Harrington TR: Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part I: A proposed computerized tomography grading scale. J Neurosurg 83:445\u2013452, 1995766622110.3171\/jns.1995.83.3.0445"},{"key":"b17","series-title":"Curr Opin Crit Care","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1097\/MCC.0b013e328332f54f","article-title":"Can the costs of critical care be controlled?","volume":"15","author":"Halpern NA","year":"2009","unstructured":"Halpern NA: Can the costs of critical care be controlled? Curr Opin Crit Care 15:591\u2013596, 200910.1097\/MCC.0b013e328332f54f19823083"},{"key":"b18","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/CCM.0b013e3181b090d0","article-title":"Critical care medicine in the United States 2000\u20132005: an analysis of bed numbers, occupancy rates, payer mix, and costs","volume":"38","author":"Halpern NA","year":"2010","unstructured":"Halpern NA, Pastores SM: Critical care medicine in the United States 2000\u20132005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med 38:65\u201371, 201010.1097\/CCM.0b013e3181b090d019730257"},{"key":"b19","series-title":"Sports Health","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1177\/1941738115622158","article-title":"Pharmacologic therapies for pediatric concussions","volume":"8","author":"Halstead ME","year":"2016","unstructured":"Halstead ME: Pharmacologic therapies for pediatric concussions. Sports Health 8:50\u201352, 201610.1177\/194173811562215826660460"},{"key":"b20","series-title":"J Am Coll Surg","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.jamcollsurg.2013.12.026","article-title":"Failure events in transition of care for surgical patients","volume":"218","author":"Helling TS","year":"2014","unstructured":"Helling TS, Martin LC, Martin M, Mitchell ME: Failure events in transition of care for surgical patients. J Am Coll Surg 218:723\u2013731, 20142450842610.1016\/j.jamcollsurg.2013.12.026"},{"key":"b21","series-title":"Scand J Trauma Resusc Emerg Med","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1757-7241-17-6","article-title":"Incidence of hospital referred head injuries in Norway: a population based survey from the Stavanger region","volume":"17","author":"Heskestad B","year":"2009","unstructured":"Heskestad B, Baardsen R, Helseth E, Romner B, Waterloo K, Ingebrigtsen T: Incidence of hospital referred head injuries in Norway: a population based survey from the Stavanger region. Scand J Trauma Resusc Emerg Med 17:6, 20091923208610.1186\/1757-7241-17-6"},{"key":"b22","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s12028-014-9986-7","article-title":"Subarachnoid hemorrhage prevalence and its association with short-term outcome in pediatric severe traumatic brain injury","volume":"21","author":"Hochstadter E","year":"2014","unstructured":"Hochstadter E, Stewart TC, Alharfi IM, Ranger A, Fraser DD: Subarachnoid hemorrhage prevalence and its association with short-term outcome in pediatric severe traumatic brain injury. Neurocrit Care 21:505\u2013513, 201410.1007\/s12028-014-9986-724798696"},{"key":"b23","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.3171\/jns.1984.60.6.1163","article-title":"Subarachnoid hemorrhage in childhood and adolescence","volume":"60","author":"Hourihan MD","year":"1984","unstructured":"Hourihan MD, Gates PC, McAllister VL: Subarachnoid hemorrhage in childhood and adolescence. J Neurosurg 60:1163\u20131166, 1984672635910.3171\/jns.1984.60.6.1163"},{"key":"b24","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1089\/neu.2013.3152","article-title":"Comprehensive assessment of isolated traumatic subarachnoid hemorrhage","volume":"31","author":"Lee JJ","year":"2014","unstructured":"Lee JJ, Segar DJ, Asaad WF: Comprehensive assessment of isolated traumatic subarachnoid hemorrhage. J Neurotrauma 31:595\u2013609, 201410.1089\/neu.2013.315224224706"},{"key":"b25","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1097\/TA.0b013e31822067fc","article-title":"Should the management of isolated traumatic subarachnoid hemorrhage differ from concussion in the setting of mild traumatic brain injury?","volume":"71","author":"Levy AS","year":"2011","unstructured":"Levy AS, Orlando A, Hawkes AP, Salottolo K, Mains CW, Bar-Or D: Should the management of isolated traumatic subarachnoid hemorrhage differ from concussion in the setting of mild traumatic brain injury? J Trauma 71:1199\u20131204, 201110.1097\/TA.0b013e31822067fc21841515"},{"key":"b26","series-title":"Pediatr Emerg Care","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/PEC.0000000000000084","article-title":"Hypertonic saline as a therapy for pediatric concussive pain: a randomized controlled trial of symptom treatment in the emergency department","volume":"30","author":"Lumba-Brown A","year":"2014","unstructured":"Lumba-Brown A, Harley J, Lucio S, Vaida F, Hilfiker M: Hypertonic saline as a therapy for pediatric concussive pain: a randomized controlled trial of symptom treatment in the emergency department. Pediatr Emerg Care 30:139\u2013145, 201410.1097\/PEC.0000000000000084"},{"key":"b27","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1227\/01.NEU.0000186013.63046.6B","article-title":"Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors","volume":"57","author":"Maas AI","year":"2005","unstructured":"Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW: Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 57:1173\u20131182, 200510.1227\/01.NEU.0000186013.63046.6B16331165"},{"key":"b28","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3171\/jns.2003.98.1.0037","article-title":"Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome","volume":"98","author":"Mattioli C","year":"2003","unstructured":"Mattioli C, Beretta L, Gerevini S, Veglia F, Citerio G, Cormio M, : Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome. J Neurosurg 98:37\u201342, 20031254635010.3171\/jns.2003.98.1.0037"},{"key":"b29","series-title":"JAMA Pediatr","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1001\/jamapediatrics.2013.311","article-title":"The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk","volume":"167","author":"Miglioretti DL","year":"2013","unstructured":"Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, : The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700\u2013707, 201310.1001\/jamapediatrics.2013.31123754213"},{"key":"b30","series-title":"Neurosurgery","first-page":"1369","article-title":"Neurological deterioration as a potential alternative endpoint in human clinical trials of experimental pharmacological agents for treatment of severe traumatic brain injuries","volume":"43","author":"Morris GF","year":"1998","unstructured":"Morris GF, Juul N, Marshall SB, Benedict B, Marshall LF: Neurological deterioration as a potential alternative endpoint in human clinical trials of experimental pharmacological agents for treatment of severe traumatic brain injuries. Neurosurgery 43:1369\u20131374, 19989848851"},{"key":"b31","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"311","DOI":"10.3171\/2008.12.PEDS08206","article-title":"Intracranial vasospasm with subsequent stroke after traumatic subarachnoid hemorrhage in a 22-month-old child","volume":"3","author":"Nahed BV","year":"2009","unstructured":"Nahed BV, Ferreira M, Naunheim MR, Kahle KT, Proctor MR, Smith ER: Intracranial vasospasm with subsequent stroke after traumatic subarachnoid hemorrhage in a 22-month-old child. J Neurosurg Pediatr 3:311\u2013315, 200910.3171\/2008.12.PEDS08206"},{"key":"b32","series-title":"Anesth Analg","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1213\/ANE.0000000000002833","article-title":"SmartTots update regarding anesthetic neurotoxicity in the developing brain","volume":"126","author":"Orser BA","year":"2018","unstructured":"Orser BA, Suresh S, Evers AS: SmartTots update regarding anesthetic neurotoxicity in the developing brain. Anesth Analg 126:1393\u20131396, 201810.1213\/ANE.000000000000283329401076"},{"key":"b33","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1097\/00003246-200004000-00037","article-title":"Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients","volume":"28","author":"Peterson B","year":"2000","unstructured":"Peterson B, Khanna S, Fisher B, Marshall L: Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients. Crit Care Med 28:1136\u20131143, 20001080929510.1097\/00003246-200004000-00037"},{"key":"b34","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1089\/neu.2014.3377","article-title":"Does isolated traumatic subarachnoid hemorrhage merit a lower intensity level of observation than other traumatic brain injury?","volume":"31","author":"Phelan HA","year":"2014","unstructured":"Phelan HA, Richter AA, Scott WW, Pruitt JH, Madden CJ, Rickert KL, : Does isolated traumatic subarachnoid hemorrhage merit a lower intensity level of observation than other traumatic brain injury? J Neurotrauma 31:1733\u20131736, 20142492661210.1089\/neu.2014.3377"},{"key":"b35","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1097\/TA.0b013e31827d6088","article-title":"The clinical significance of isolated traumatic subarachnoid hemorrhage","volume":"74","author":"Quigley MR","year":"2013","unstructured":"Quigley MR, Chew BG, Swartz CE, Wilberger JE: The clinical significance of isolated traumatic subarachnoid hemorrhage. J Trauma Acute Care Surg 74:581\u2013584, 20132335425410.1097\/TA.0b013e31827d6088"},{"key":"b36","series-title":"Health Psychol Behav Med","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1080\/21642850.2014.943760","article-title":"Posttraumatic stress in intensive care unit survivors - a prospective study","volume":"2","author":"Ratzer M","year":"2014","unstructured":"Ratzer M, Brink O, Knudsen L, Elklit A: Posttraumatic stress in intensive care unit survivors - a prospective study. Health Psychol Behav Med 2:882\u2013898, 20142575082410.1080\/21642850.2014.943760"},{"key":"b37","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1089\/neu.2016.4415","article-title":"Predicting blunt cerebrovascular injury in pediatric trauma: validation of the \u201cUtah Score\u201d","volume":"34","author":"Ravindra VM","year":"2017","unstructured":"Ravindra VM, Bollo RJ, Sivakumar W, Akbari H, Naftel RP, Limbrick DD Jr, : Predicting blunt cerebrovascular injury in pediatric trauma: validation of the \u201cUtah Score\u201d. J Neurotrauma 34:391\u2013399, 20172729777410.1089\/neu.2016.4415"},{"key":"b38","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"599","DOI":"10.3171\/2014.11.PEDS14397","article-title":"Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study","volume":"15","author":"Ravindra VM","year":"2015","unstructured":"Ravindra VM, Riva-Cambrin J, Sivakumar W, Metzger RR, Bollo RJ: Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study. J Neurosurg Pediatr 15:599\u2013606, 201510.3171\/2014.11.PEDS1439725745952"},{"key":"b39","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"944","DOI":"10.3171\/2014.6.JNS132204","article-title":"Outpatient follow-up of nonoperative cerebral contusion and traumatic subarachnoid hemorrhage: does repeat head CT alter clinical decision-making?","volume":"121","author":"Rubino S","year":"2014","unstructured":"Rubino S, Zaman RA, Sturge CR, Fried JG, Desai A, Simmons NE, : Outpatient follow-up of nonoperative cerebral contusion and traumatic subarachnoid hemorrhage: does repeat head CT alter clinical decision-making? J Neurosurg 121:944\u2013949, 201410.3171\/2014.6.JNS13220425061865"},{"key":"b40","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"307","DOI":"10.3171\/2013.12.PEDS13223","article-title":"Computed tomography characteristics in pediatric versus adult traumatic brain injury","volume":"13","author":"Sarkar K","year":"2014","unstructured":"Sarkar K, Keachie K, Nguyen U, Muizelaar JP, Zwienenberg-Lee M, Shahlaie K: Computed tomography characteristics in pediatric versus adult traumatic brain injury. J Neurosurg Pediatr 13:307\u2013314, 201410.3171\/2013.12.PEDS1322324410128"},{"key":"b41","series-title":"Int Emerg Nurs","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.ienj.2016.11.003","article-title":"Early neurological deterioration in older adults with traumatic brain injury","volume":"37","author":"Scheetz LJ","year":"2018","unstructured":"Scheetz LJ, Horst MA, Arbour RB: Early neurological deterioration in older adults with traumatic brain injury. Int Emerg Nurs 37:29\u201334, 20182808207210.1016\/j.ienj.2016.11.003"},{"key":"b42","series-title":"Brain Inj","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1080\/02699052.2018.1439533","article-title":"Post-concussive symptoms after a mild traumatic brain injury during childhood and adolescence","volume":"32","author":"Starkey NJ","year":"2018","unstructured":"Starkey NJ, Jones K, Case R, Theadom A, Barker-Collo S, Feigin V: Post-concussive symptoms after a mild traumatic brain injury during childhood and adolescence. Brain Inj 32:617\u2013626, 201810.1080\/02699052.2018.143953329446658"},{"key":"b43","series-title":"Aust Crit Care","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.aucc.2014.04.003","article-title":"Posttraumatic stress disorder in close Relatives of Intensive Care unit patients\u2019 Evaluation (PRICE) study","volume":"27","author":"Sundararajan K","year":"2014","unstructured":"Sundararajan K, Martin M, Rajagopala S, Chapman MJ: Posttraumatic stress disorder in close Relatives of Intensive Care unit patients\u2019 Evaluation (PRICE) study. Aust Crit Care 27:183\u2013187, 201410.1016\/j.aucc.2014.04.00324813077"},{"key":"b44","series-title":"Ann Emerg Med","first-page":"431","article-title":"Clinical presentations and outcomes of children with basilar skull fractures after blunt head trauma","volume":"68","author":"Tunik MG","year":"2016","unstructured":"Tunik MG, Powell EC, Mahajan P, Schunk JE, Jacobs E, Miskin M, : Clinical presentations and outcomes of children with basilar skull fractures after blunt head trauma. Ann Emerg Med 68:431\u2013440, 440.e1, 2016"},{"key":"b45","series-title":"World J Surg","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.1007\/s00268-017-4408-6","article-title":"Blunt cerebrovascular artery injury and stroke in severely injured patients: an international multicenter analysis","volume":"42","author":"Weber CD","year":"2018","unstructured":"Weber CD, Lefering R, Kobbe P, Horst K, Pishnamaz M, Sellei RM, : Blunt cerebrovascular artery injury and stroke in severely injured patients: an international multicenter analysis. World J Surg 42:2043\u20132053, 201810.1007\/s00268-017-4408-629270652"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/22\/5\/article-p559.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/22\/5\/article-p559.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/22\/5\/article-p559.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:42:29Z","timestamp":1681566149000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/22\/5\/article-p559.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":45,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2018.5.peds18140","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}