Growth monitoring following traumatic brain injury
R J Moon1, P Wilson, F J Kirkham
1Paediatric Endocrinology, Southampton University Hospitals NHS Trust, Southampton, UK.
Insights
Growth monitoring is crucial for children with traumatic brain injury (TBI) to detect hypopituitarism. However, this study found poor documentation and inconsistent follow-up of growth in TBI patients, indicating a need for better coordinated care.
Area of Science:
- Pediatric Endocrinology
- Neurotrauma
- Clinical Audit
Background:
- Hypopituitarism is a significant sequela of traumatic brain injury (TBI).
- Growth monitoring serves as a key indicator of pituitary function in pediatric TBI survivors.
- Current follow-up practices for growth in these children are not well-defined.
Purpose of the Study:
- To evaluate the quality and consistency of growth monitoring in children following TBI.
- To identify deficiencies in the current follow-up protocols for pediatric TBI patients regarding growth assessment.
Main Methods:
- Retrospective audit of case notes for 123 children admitted to intensive care with TBI.
- Analysis of documented height and weight measurements from clinic attendances.
- Assessment of serial growth measurements and changes in height standard deviation scores.
Main Results:
- Only 33% of recorded clinic attendances (71/212) in 38 children had documented height and weight.
- Growth monitoring frequency varied significantly across 11 different specialty clinics.
- Serial growth data was available for only 17% of patients (22/123), showing a significant reduction in height standard deviation scores over time.
Conclusions:
- Growth monitoring following TBI in children is inadequately performed in the studied cohort.
- There is a critical need for a coordinated, multidisciplinary approach to growth monitoring in pediatric TBI follow-up.
- Improved collaboration between primary, secondary, and tertiary care is essential for optimal patient outcomes.
Abstract:
Hypopituitarism is an important consequence of traumatic brain injury (TBI). Growth monitoring can be used as an indicator of pituitary function in children. A retrospective audit of case notes of 123 children who required intensive care unit admission with TBI found that only 71 (33%) of 212 attendances in 38 of 85 children followed up had documented height and weight measurements. Children were reviewed in 11 different specialty clinics, which showed a wide variation in the frequency of growth monitoring. Serial growth measurements were available for only 22 patients (17%), which showed a reduction in height standard deviation scores (0.17 (SD 0.33), p = 0.017) over a mean follow-up period of 25.2 (SD 21.6) months. In conclusion, growth monitoring following TBI was poorly performed in this cohort, highlighting the need for a co-ordinated approach by primary and secondary care and all departments in tertiary centres involved in the follow-up of children with TBI.
