Outcomes following childhood head injury : a population study

Objectives: To identify outcomes following head injury (HI) amongst a population of children admitted to one hospital centre and compare outcomes between different severity groups. Methods:A postal follow-up of children admitted with HI to one NHS Trust, between 1992-1998, was carried out. Children were aged 5-15 years at injury (mean 9.8), followed-up at a mean of 2.2 years post-injury. Parents of 526 injured children (419 mild, 58 moderate, 49 severe) and 45 controls completed questionnaires. Outcomes were assessed using the King’s Outcome Scale for Childhood Head Injury (KOSCHI). Results:Frequent behavioural, emotional, memory and attentional problems were reported by one third of the severe group, one quarter of the moderate, and 10-18% of the mild. Personality change since HI was reported for 148 children (28%) (21% mild HI, 46% moderate, 69% severe). There was a significant relationship between injury severity and KOSCHI outcomes. Following the HI, 252(48%) had moderate disability (43% mild HI, 64% moderate, 69% severe), 270(51%) made a good recovery (57% mild HI, 36% moderate, 22% severe). There was a significant association between social deprivation and poor outcome (p=0.002). Only 30%(158) of children received hospital follow-up after the HI. All children with severe disability received appropriate follow-up, but 64% of children with moderate disability received none. No evidence was found to suggest a threshold of injury severity below which the risk of late sequelae could be safely discounted. Conclusions:Children admitted with mild HI may be at risk of poor outcomes, but often do not receive routine hospital follow-up. A postal questionnaire combined with the KOSCHI to assess outcomes after HI may be used to identify children who would benefit from clinical assessment. Further research is needed to identify factors which place children with mild HI at risk of late morbidity

Return to school after brain injury

Objective: To examine return to school and classroom performance following traumatic brain injury (TBI) Design: Cross-sectional Setting: Community Subjects: 67 school-age children with TBI (35 mild, 13 moderate, 19 severe), and 14 uninjured matched controls. Interventions: Parents and children were interviewed and children assessed at a mean of two years post injury. Teachers reported on academic performance and educational needs. Main measures: Classroom performance, Children’s Memory Scale (CMS), WISC-III, WORD. Results: One third of teachers were unaware of the TBI. On return to school, special arrangements were made for 18 children (27%). Special educational needs were identified for 16 (24%), but only six children (9%) received specialist help. Two-thirds of children with TBI had difficulties with school-work, half had attention/concentration problems and 26 (39%) had memory problems. Compared to other pupils in the class, one third of children with TBI were performing below average. On the CMS, one third of the severe group were impaired/borderline for immediate and delayed recall of verbal material, and over one quarter were impaired/borderline for general memory. Children in the severe group had a mean full-scale IQ significantly lower than controls. Half the TBI group had a reading age ≥1 year below their chronological age, one third were reading ≥2 years below chronological age. Conclusions: Schools rely on parents to inform them about a TBI, and rarely receive information on possible long-term sequelae. At hospital discharge, health professionals should provide schools with information about TBI and possible long-term impairments, so that children returning to school receive appropriate support

Parental stress and burden following traumatic brain injury amongst children and adolescents

Primary objectives: to assess parental stress following paediatric traumatic brain injury (TBI) and examine the relationship between self-reported problems and parental stress and general health. Research design: controlled interview study Methods and procedures: Parents of ninety-seven children admitted with a TBI (49 mild, 19 moderate, 29 severe) were identified from a case register of all paediatric admissions from 1992-1998. Parents of 31 uninjured children acted as controls. Structured interviews were carried out with families, and parents assessed on the Parenting Stress Index (PSI/SF) and General Health Questionnaire (GHQ-12) at recruitment, and repeated 12 months later. Main outcomes and results: regardless of injury severity, parents of injured children suffered greater stress than control parents as measured by the PSI/SF (p = 0.001). There was a highly significant relationship between number of problems reported and level of parental stress (p = 0.001). Financial burden was related to severity of TBI. Conclusions: improved information, follow-up, and support is likely to reduce parental stress and family burden

Children's brain injury : a postal follow-up of 525 children from one health region in the UK

Primary objectives: to follow-up a population of children admitted to one Hospital Trust with traumatic brain injury (TBI), and compare outcomes following mild TBI with outcomes following moderate or severe TBI. Research design: population-based postal questionnaire survey. Methods and procedures: questionnaires were mailed to parents of all 974 surviving children on a register of paediatric TBI admissions, 525 completed questionnaires were returned (56.2%). Most children (419) had suffered mild TBI, 57 moderate, and 49 severe. Main outcomes and results: Thirty percent of parents received no information on post-injury symptoms, and clinical follow-up was limited. Statistically significant differences were observed between mild and moderate/severe groups for cognitive, social, emotional, and mobility problems. Nevertheless, approximately 20% of the mild group suffered from poor concentration, personality change, and educational problems post-injury. Few schools (20%) made special provision for children returning after injury. Conclusions: children can have long lasting and wide ranging sequelae following TBI. Information should be routinely given to parents and schools after brain injury

Prevalence of traumatic brain injury amongst children admitted to hospital in one health district : a population-based study

There is a dearth of information regarding the prevalence of brain injury, serious enough to require hospital admission, amongst children in the United Kingdom. In North Staffordshire a register of all children admitted with traumatic brain injury (TBI) has been maintained since 1992 presenting an opportunity to investigate the incidence of TBI within the region in terms of age, cause of injury, injury severity and social deprivation. The register contains details of 1553 children with TBI, two thirds of whom are male. This population-based study shows that TBI is most prevalent amongst children from families living in more deprived areas, however, social deprivation was not related to the cause of injury. Each year, 280 per 100,000 children are admitted for ≥24 hours with a TBI, of these 232 will have a mild brain injury, 25 moderate, 17 severe, and 2 will die. The incidence of moderate and severe injuries is higher than previous estimates. Children under 2 years old account for 18.5% of all TBIs, usually due to falls, being dropped or non-accidental injuries. Falls account for 60% of TBIs in the under 5s. In the 10-15 age group road traffic accidents were the most common cause (185, 36.7%). These findings will help to plan health services and target accident prevention initiatives more accurately