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Pediatric closed head injury: outcome following prolonged unconsciousness
R L Kriel1, L E Krach, M Sheehan
1Department of Pediatric Neurology, Gillette Children's Hospital, St. Paul, MN 55101.
Insights
Children with prolonged unconsciousness after traumatic brain injury showed better recovery if they had minimal brain atrophy on CT scans. Minimal computerized brain scan (CT) atrophy predicted good outcomes in older children.
Area of Science:
- Pediatric Neurology
- Neurotraumatology
- Rehabilitation Medicine
Background:
- Traumatic brain injury (TBI) in children can lead to prolonged states of unconsciousness.
- Predicting long-term outcomes in pediatric TBI patients is crucial for guiding treatment and family support.
- Understanding the relationship between early brain imaging findings and functional recovery is essential.
Purpose of the Study:
- To describe the outcomes of children with prolonged unconsciousness ( > 90 days) following traumatic brain injury.
- To identify early predictors of neurological recovery and functional independence in this patient group.
- To assess the utility of computerized brain scans (CT scans) in predicting cognitive and motor outcomes.
Main Methods:
- Retrospective analysis of 26 pediatric patients with TBI who remained unconscious for over 90 days.
- Evaluation of neurological recovery, including regaining consciousness, communication ability, and independent ambulation.
- Correlation of functional outcomes with cerebral atrophy measurements from computerized brain scans (CT scans) obtained two months post-injury.
Main Results:
- Twenty out of 26 children regained consciousness; 11 achieved communication, and 5 could ambulate independently.
- Minimal cerebral atrophy on CT scans at two months post-injury was a significant predictor of better recovery (IQ ≥ 70) (p = 0.001).
- In patients older than 12 years, minimal CT atrophy accurately predicted a good outcome in 89% of cases.
Conclusions:
- Early assessment of cerebral atrophy using CT scans can help predict functional recovery in children with severe TBI and prolonged unconsciousness.
- Minimal brain atrophy is a strong positive prognostic indicator, particularly in older pediatric TBI patients.
- These findings support the use of early neuroimaging in managing expectations and planning rehabilitation for children with severe TBI.
Abstract:
This report describes outcomes for a group of 26 children who remained unconscious longer than 90 days after traumatic brain injury. Twenty children regained consciousness; 11 are able to communicate. Five children can ambulate independently. In this series, children with the best recovery (IQ greater than or equal to 70) were predicted by minimal cerebral atrophy, demonstrated by computerized brain scan (CT scan) performed two months after injury (p = 0.001). In subjects over 12 years old, minimal CT atrophy predicted a good outcome with 89% accuracy.