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[Traumatic brain injury in children]
1Department of Pediatrics, Kanagawa Rehabilitation Center, Atsugi.
Insights
Traumatic brain injuries in children often result from traffic accidents or abuse. Factors like chronic subdural hematoma and prolonged unconsciousness predict poor prognosis, impacting long-term daily living activities and school reintegration.
Area of Science:
- Pediatrics
- Neurology
- Traumatology
Background:
- Traumatic brain injury (TBI) is a significant cause of childhood morbidity.
- Understanding prognostic factors is crucial for effective management and rehabilitation.
Observation:
- This study analyzed 42 children with TBI, primarily from traffic accidents (46%) and child abuse (7%).
- Common injuries included acute subdural hematoma (43%), diffuse axonal injury (21%), and chronic subdural hematoma (10%, exclusively from abuse).
- Good prognosis (independent ADL) was associated with diffuse axonal injury, while poor prognosis (dependent ADL) linked to abuse-related chronic subdural hematoma and severe/prolonged unconsciousness (GCS < 8).
Findings:
- Fifteen children had a good prognosis, with diffuse axonal injury being the most common diagnosis.
- Twelve children experienced a poor prognosis, characterized by complete dependence in activities of daily living (ADL).
- Bad prognostic indicators included child abuse-related chronic subdural hematoma and loss of consciousness (Glasgow Coma Scale < 8) lasting over two weeks.
Implications:
- 37 children returned to school post-rehabilitation, with 20 in ordinary classes.
- Approximately half reintegrated into standard classrooms, but many faced challenges like learning difficulties and social issues.
- Early identification of prognostic factors and targeted rehabilitation are vital for improving outcomes in pediatric TBI.
Abstract:
We investigated the prognosis of 42 children with traumatic brain injuries. The main etiology was a traffic accident in 46 cases, especially during walking and bicycling, and child abuse in 7 cases. Eighteen cases of acute subdural hematoma 18 cases distributed at all ages, 9 cases of diffuse axonal injury mainly during school age, 4 cases of chronic subdural hematoma under 2 years. These were all caused by child abuse. Fifteen cases showed a good prognosis with independent activities of daily living (ADL). The main type of injury was diffuse axonal injury in this group. Twelve cases showed a bad prognosis with completely dependent ADL. The bad prognostic factors were chronic subdural hematoma caused by child abuse, consciousness loss with Glasgow Coma Scale less than 8 or lasting more than 2 weeks. After rehabilitation in our hospital, 37 cases returned to school: an ordinary class in 20 cases, a special class in an ordinary school in 5 cases and a special class in 12 cases. About half of the cases returned to an ordinary class, although with problems such as learning difficulty, danger and bullying.