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Summer Research Projects for Vanderbilt Pediatric Neurosurgery Clinical Research Initiative Katherine Kelly Chiari Quality of Life Study Prospective Study Future Development Craniofacial Retrospective Study Monroe Carell Jr. Children’s Hospital at Vanderbilt University Department of Neurosurgery: Dr. John Wellons, Dr. Noel Tullipian, Dr. Chevis Shannon Departments of Craniofacial Surgery and Plastic Surgery: Dr. Kevin Kelly, Marcia Spear Peer Colleagues: Kelly Pekala, James Leathers, Travis Ladner, Reagan Caldwell Future Development Traumatic Brain Injury Retrospective Study Introduction: The purpose of our study was to retrospectively evaluate patient characteristics and factors influencing clinical decision making in an effort to inform an ongoing discussion centered on standardization of treatment and management for traumatic brain injury (TBI) patients. Methods: A retrospective study of 1836 children undergoing treatment and management for TBI between January 2006 and April 2013 at the Vanderbilt University Children’s Hospital was conducted. Descriptive statistics, multivariate and logistic regression were conducted using SAS 9.3 Results: We found that 63% of our cohort was male, 77% were Caucasian, and over 75% presented alert and were discharged home. The mean age was 7.6 years (stdev 5.83). Approximately 50% of our cohort required ICU days of 3 or less while 40% required greater than 14 days in the ICU. Bleed characteristics including epidurals, subdurals, subarachnoid hemorrhage, and radiographic characteristics including bilaterality of bleeding, retinal hemorrhage and midline shift were evaluated. Of these factors, subdurals, epidurals, age, and low GCS were associated with ICU stays of 7 days or greater (p<.0001) Additionally, prolonged seizure activity, high glucose levels and subdural hematomas were found to be associated with hospital disposition other than home (p< .0001). Conclusion: The purpose of this study was to retrospectively review our institution’s trauma patient population as a step towards standardization of clinical care. This descriptive study will inform a TBI protocol and multidisciplinary clinical pathway that will be used among the pediatric neurosurgery, emergency department and critical care teams at VCH. Abstract Figure 1. Some Patient Variables Collected Currently, this manuscript along with others stemming from the same TBI database are in the process of being written. This abstract awaits review from the American Association of Neurological Surgeons for their annual meeting in Toronto, Canada in December. Pending their approval, we hope to present this manuscript in the form of an oral presentation or a poster at the meeting. The information gathered from this study potentially could be used to enhance the current TBI protocol at Vanderbilt University Children’s Hospital, enabling resource utilization and improving clinical care for pediatric TBI patients. In order to understand the quality of life for children with Chiari I Malformation better, the Vanderbilt University Children’s Hospital is conducting a prospective study on these patients. Current pediatric patients presenting with a Chiari I malformation in the neurosurgery clinic are eligible for this study. Patients are asked to fill out an already validated survey, the HUI3, in addition to a new survey called the CMIC, which evaluates patients in terms of cognitive, psychosocial and somatic symptoms. They will fill out the same two surveys at five successive stages: first two consults and then 3 months, 6 months and one year after surgery. The patients’ responses are then quantified in a database and compared. Figure 2. The below images are the two surveys that the patients receive. The first is the validated HUI3, and the second is the new CMIC survey. Basic Overview Current Progress This study is currently in the process of patient enrollment at Vanderbilt Children’s Hospital. At the end of August 2013, we have enrolled 11 pediatric patients. In order to fully evaluate our patient population, we are also planning to include patients who have a whole range of symptoms and care, including surgical and nonsurgical candidates and patients who have headaches but not a Chiari I Malformation. We hope that with the comparison of these groups after our patients complete each survey, our results will provide more information on the quality of life for pediatric patients with Chiari I Malformation and highlight a need for protocol change. The Vanderbilt Pediatric Neurosurgery Clinical Research Initiative wants to incorporate many different research departments in order to create multidisciplinary collaboration and conduct research from the perspective of the patient as a whole, instead of only a particular subdivision. With this in mind, the Pediatric Neurosurgery department has paired with the pediatric Plastic Surgery and Pediatric Craniofacial Surgery Departments to study patients who underwent surgery for craniosynostosis. This project is in the preliminary stages. After gathering a database of 327 pediatric patients who underwent surgery for craniosynostosis from the time period of 1998-2008 at Vanderbilt Children’s Hospital, the patients were further analyzed for additional neurosurgery and plastic surgery problems (See Figure 4 below) A Multidisciplinary Approach The project is currently in the stage of data analysis. We are first investigating different craniofacial implications (See Figure 5 below). After the analysis of the solely craniofacial aspect of this pediatric patient population, we will move to analyze these patients for further neurological and plastic surgical disorders, hoping to identify a connection. We aim to establish lasting collaboration between the several surgical departments and enable further multidimensional research. Acknowledgements
