Long-term follow-up review of 31 children with severe closed head trauma
H Costeff1, Z Groswasser, R Goldstein
1Neuropediatric Unit, Loewenstein Hospital, Ra'anana, Israel.
Insights
Severe pediatric head trauma significantly impairs children long-term, causing major permanent disability in most survivors. Cognitive deficits and social problems are common, with outcomes linked to initial brain injury severity shown on CT scans.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Traumatology
Background:
- Severe closed head trauma in children can lead to long-term neurological deficits.
- Understanding the spectrum of disabilities and recovery patterns is crucial for pediatric neurotrauma care.
Purpose of the Study:
- To assess the long-term functional outcomes in children surviving severe closed head trauma.
- To identify factors influencing disability and recovery after pediatric traumatic brain injury.
Main Methods:
- Longitudinal follow-up of 31 children (aged 3-15 years) for 5-11 years post-severe closed head trauma.
- Assessment of motor, cognitive, and social abilities.
- Correlation of outcomes with acute-stage computerized tomography (CT) scan findings.
Main Results:
- 24 out of 30 survivors had major permanent disability.
- Common disabilities included spastic hemiparesis, basal ganglia syndromes, and ataxia.
- Only 10 children could benefit from normal education; none pursued higher education.
- Worst outcomes correlated with intracranial bleeding/contusion on CT scans; best outcomes with normal CT scans.
Conclusions:
- Severe pediatric head trauma results in significant and lasting disabilities, comparable to adults.
- Early CT findings are predictive of long-term outcomes.
- Comprehensive rehabilitation and support are essential for children with traumatic brain injury.
Abstract:
Thirty-one children aged 3 to 15 years were followed for 5 to 11 years after suffering severe closed head trauma which caused coma for 1 week or more (median duration of coma 3 weeks). One patient remained in a persistent vegetative state until his death 9 years later. The other 30 recovered consciousness and were discharged. All suffered diminution of their abilities, and 24 of them had major permanent disability. The most common motor disabilities were pure spastic hemiparesis (seven cases), basal ganglia syndromes (four cases), ataxia (three cases), and a combination of hemiparesis and ataxia (five cases). Of the 30 patients, 26 regained independent ambulation, seven were epileptic, and 14 were dysarthric in various degrees. Only 10 had the cognitive ability to profit from the normal educational system, and none had attempted postsecondary education. Social problems were common. The worst outcomes were associated with intracranial bleeding and/or brain contusion seen on computerized tomography (CT) scans at the acute stage; the best were associated with normal CT scans. The degree of residual disability in these children seems no less than that of adults with trauma of similar severity.
