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[Prognostic evaluation of severe head injuries in children]
C Jeannin1, E Straub, D Devictor
1Services de Neurologie pédiatrique, de Réanimation pédiatrique et de Santé Publique et d'Epidémiologie, CHU Bicêtre.
Insights
Severe head injury in children significantly impacts quality of life, primarily due to neuropsychological deficits like impaired intelligence and memory. Early CT findings and prolonged coma indicate a poorer prognosis for these pediatric patients.
Area of Science:
- Pediatric Neurology
- Neuropsychology
- Traumatic Brain Injury
Context:
- Study focuses on 34 children with severe head injuries (coma > 1 day).
- Follow-up period averaged 25 months post-injury.
- Investigates correlations between injury severity, sequelae, and long-term outcomes.
Purpose:
- To correlate clinical data and early findings with the quality of life and overall outcome in children post-severe head injury.
- To assess the predictive value of early versus later neuropsychological evaluations.
Summary:
- Quality of life is strongly linked to neuropsychological sequelae, particularly intelligence and memory deficits.
- Prolonged coma (>10 days) and subdural collections on CT scans (2-6 weeks post-injury) are associated with negative outcomes.
- Neuropsychological evaluation at 6 months post-injury is a reliable predictor of long-term outcome, though some late improvements may occur.
Impact:
- Highlights the critical role of neuropsychological recovery in determining quality of life after pediatric head trauma.
- Identifies key prognostic indicators for better clinical management and patient counseling.
- Emphasizes the importance of 6-month follow-up for predicting functional outcomes in pediatric TBI survivors.
Abstract:
In 34 children overcoming a severe head injury (coma greater than 1 d, mean: 10 d), the follow-up (mean: 25 m) has been correlated with several data. 1) The quality of life, according to a 3 grade-score, is mostly dependent upon the degree of neuropsychological sequelae. By decreasing frequency were noted disturbances of: memory, intelligence (the most significantly correlated with the quality of life), attention, rapidity of performances, behaviour, visuoconstructive activities. Most often several disturbances were associated, but without systematization. 2) Correlations between general outcome and early findings: a coma greater than 10 d, a subdural collection on the CT scan at 2-6 weeks have a pejorative meaning. Age does not appear to be relevant. 3) In a sequential study of neuropsychological functions, an early evaluation is poorly predictive, except in case of rapid normalization. Evaluation at 6 months gives a good picture of the outcome. Sectorial improvements can occur beyond the 1st year but do not appear to modify dramatically the general outcome.