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Long-term outcome after severe brain injury in preschoolers is worse than expected
M Koskiniemi1, T Kyykkä, T Nybo
1Kauniala Hospital for Disabled War Veterans, Kauniainen, Finland.
Objective:
To determine the long-term outcome after severe brain injury at preschool age.
Design:
Follow-up until adult life.
Setting:
A centralized guidance center for all traffic-associated injuries.
Patients:
Children with severe brain injury at preschool age between January 1959 and December 1969.
Main Outcome Measure:
Final evaluation in adulthood was performed by our team. The capability to work and live independently was rated.
Results:
Twenty three (59%) of 39 children attended a typical school, eight (21%) attended a school for the physically disabled, and seven (18%) attended a school for the mentally retarded; information was not available for one child. In adulthood, nine patients (23%) were able to work full-time, 10 (26%) worked at sheltered workplaces, 14 (36%) lived independently at home, and six (15%) needed physical and/or psychotherapeutic support. The difference between normal school performance (59%) and capability to work full-time (23%) was significant (P < .05). In evaluating different aspects after the severe brain injury, the sense of identity was the best indicator of final outcome.
Conclusions:
The final evaluation of severe brain injury at preschool age should be performed in adulthood. Normal school performance or normal intelligence functioning is not a guarantee for good long-term prognosis. To let the child develop a firm identity is essential for good outcome.