Head Injuries in Children – long-term consequences

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It stands to reason that head injuries could lead to brain injury and it follows that low force injuries tend to result in a low risk of brain injury, but significant force injuries carry a high risk of mild, moderate or even severe brain injury.

Prevention is always best.  However, irrespective of the precautions we take head injuries can, and do, occur.

When a child suffers a head injury it can be particularly distressing.  If brain trauma has occurred, what is the prognosis?  What are the effects of the injury? Will my child recover? When?

Most research on childhood traumatic head injury has concentrated on the short-term effects of injury, no more than 15 years following the initial trauma.  Little research has been undertaken with regard to the long-term effects of traumatic brain injury from childhood to adulthood.

However, a research study by Harry Klonoff, Campbell Clark and Pamela S Klonoff, reported in the Journal of Neurology, Neurosurgery, and Psychiatry provides definitive reading.  The purpose of this substantive study was to consider the long-term outcome of head injuries in children. The study holds good today. 

It concerned a 23 year follow-up of a study initially undertaken in 1967 and 1968.  The initial study included 231 children (147 boys and 84 girls) who had sustained a head trauma at an average age of 8.32 years at the time of injury. It covered the period from the time of the trauma to the 5th year after trauma.

During 1990 to 1991, 175 of the individuals in the original project were traced, and 159 of them agreed to volunteer to further research.  Their average age was now 31.40 years; 105 males and 54 females.  Their average age at the time of head trauma equated to 7.96 years. 

Rather than the previous method of measuring a patient's recovery, i.e. interviewer ratings, research focused more on patient interviews and data compiled from patients compared with that of their families.  Previous data held by the hospital was unknown to the interviewer and the volunteer.  Further, the information was now provided by the adult volunteer in most cases as opposed to a parent, generally the mother, as was the case during the initial project.

Variables with regard to each patient were taken into account.  The period of unconsciousness, whether or not a skull fracture had been sustained, EEG ratings, post-traumatic seizures and a patient's neurological status were all used as indicators of the extent of injury.  In addition, a composite measure was derived by summing these five variables.

Outcomes were analysed allowing for the patient's pre-accident personality, IQ, educational placement, sex and age, etc. Whether the injury was a result of a fall, automobile accident or other were also considered as was the length of hospitalisation.  Further, it was noted whether there were multiple injuries (and any previous or subsequent head injuries). Whether or not litigation had been intimated was also considered as an element contributing to increased symptoms.

Consideration was given to the any ongoing complaints such as personality changes, mood, headaches, dizziness, memory, learning, sensory-motor, fatigue and sleep, etc.

Summary of results

Post injury behaviour and scholastic problems are unlikely to resolve over time, despite a partial recovery of cognitive functions.  However, results will be variable and will depend on many factors. 

The following were found to be the most reliable predictors of long-term outcome:

• The severity of the head injury;

• The composite measure of neurological variables - i.e. consideration of all variables - the period of unconsciousness, whether or not a skull fracture had been sustained, EEG ratings, post-traumatic seizures and a patient's neurological status;

• IQ recorded in the post-acute phase.
It was found that individual differences in disposition and age were not relevant.  Intervening life events undoubtedly had an effect, but it was not possible to determine to what extent. 

So, in answer to the questions raised above - What are the effects of the injury? Will my child recover? When? – There is no definitive answer to any of these questions.  The effects and recovery cannot be accurately ascertained without extensive investigation.  Clearly further research is needed to provide both patients and their families with a framework in which to work.

Deborah Blackmore


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