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Pediatric rehabilitation of severe acquired brain injury: a multicenter survey
S Gazzellini1, S Strazzer, M Stortini
1Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy. simone.gazzellini@opbg.net
Insights
This study highlights that traumatic causes are the most common for severe acquired brain injuries (ABI) in Italian children, with car accidents being a major factor. Early specialized rehabilitation is crucial for better outcomes in pediatric ABI patients.
Area of Science:
- Pediatric neurorehabilitation
- Acquired brain injury epidemiology
- Clinical outcomes research
Background:
- Limited epidemiological data exists on pediatric severe acquired brain injuries (ABI) in Italy.
- Previous research indicates traumatic etiologies are most prevalent in ABI.
- Greater clinical impairments are observed in patients with non-traumatic etiologies.
Purpose of the Study:
- To define clinical features of pediatric patients with severe neurological disabilities.
- To determine the etiology and onset of cerebral lesions in pediatric ABI.
- To analyze rehabilitation processes and patient outcomes, including disability and treatment strategies.
Main Methods:
- A quasi-epidemiological, in-patient study involving 184 pediatric patients with severe ABI.
- Data collected via an assessment protocol across multiple Italian neurorehabilitation centers.
- Separate analysis of traumatic and non-traumatic etiologies (NTBI).
Main Results:
- Traumatic etiology was most prevalent (51.6%), with males affected twice as often as females.
- Car accidents accounted for 70.5% of traumatic ABI cases, indicating a key area for prevention.
- The positive recovery trend for traumatic brain injury (TBI) patients was steeper than for NTBI patients.
Conclusions:
- This is the first Italian descriptive study on pediatric ABI of traumatic or non-traumatic origin.
- Rehabilitation must account for etiological differences; acute ABI can cause long-term disability.
- Specialized pediatric rehabilitation centers are vital, and ABI prevention efforts are essential.
Background:
Epidemiological and descriptive data concerning the clinical and socio-demographic characteristics of severe acquired brain injuries (ABI) in pediatric age are meager. In particular, in Italy we only find data concerning traumatic brain injury (TBI) in adults. Earlier data show that the most prevalent etiology in ABI is traumatic and that greater clinical impairments are reported for patients with non-traumatic etiologies.
Aim:
The main aims of the GISCAR (Gruppo Italiano per lo Studio delle Gravi Cerebrolesioni Acquisite e Riabilitazione) study are: 1) to define the clinical features of pediatric patients with severe neurological disabilities; 2) to determine the etiology and onset modality of the cerebral lesions; and 3) to analyse the characteristics of the rehabilitation processes and patient outcome in terms of disability, strategies for treatment and clinical picture.
Design:
Quasi-epidemiologic.
Setting:
In-patient.
Population:
184 pediatric patients with severe ABI were recruited.
Methods:
Data collection was done by means of an assessment protocol created and used by a group of Italian neurorehabilitation centers. Traumatic and non traumatic aetiologies (NTBI) have been treated separately.
Results:
Traumatic etiology of ABI is the most prevalent (51.6%, N. 95) and about twice as many males as females are involved. Of these cases, 70.5% (N. 67) are the result of a car accident, either as a pedestrian or as a passenger, representing a crucial area for preventive action by the public health services. Eighty-six (46.7%) patients were in the acute state, 19 (10.3%) in subacute state and 76 (42.9%) in chronic condition. The results show that the positive trend for the TBI group was steeper than for NTBIs. Neuropsychological data are also discussed. CONCLUSIONS AND CLINICAL REHABILITATION IMPACT: We report the first Italian descriptive study on pediatric patients affected by ABI of traumatic or non traumatic etiology. The main points concerning rehabilitation are that major differences between aetiologies must be taken into account and that ABI of any severity in the acute phase may lead to long term disability, confirming the high social and economic impact of this pathology. Our study demonstrates the great importance of providing specialised rehabilitation centers for pediatric patients, and increases awareness of the importance of ABI prevention.
