Inflicted Traumatic Brain Injury: Relationship of Developmental Outcome to Severity of Injury

Abstract

Inflicted traumatic brain injury (TBI) is a frequent consequence of physical child abuse in infants and children. Twenty-eight children who were 2–42 months of age when hospitalized for moderate to severe TBI were enrolled in a prospective, longitudinal study of neurobehavioral outcome following acquired brain injury. Relative to a comparison group, the children with inflicted TBI had significant deficits in cognitive, motor and behavioral domains when assessed with the Bayley Scales of Infant Development-II 1 and 3 months after the injury. Nearly half of the injured children showed persisting deficits in attention/arousal, emotional regulation and motor coordination. Greater injury severity, as indicated by lower coma scale scores, longer periods of unconsciousness and the presence of edema/cerebral infarctions was associated with poorer outcomes in all domains.

Predictors of Outcome following Traumatic Brain Injury in Young Children

“…It is possible that the modest recovery in younger children is restricted by their smaller and less well-established skill repertoire, which is more prone to disruption by diffuse brain injury. Young children with TBI are at risk of increasing developmental deficits over time due to lower cognitive functioning as well as deficits in the areas of regulation of attention, initiating social interactions and responding to the social behavior of others [22]. Additionally, there is a higher incidence of inflicted TBI in very young children and the presence of inflicted brain injury adversely influences outcome.…”

“…The GOS should be modified to reflect the unique issues of assessing functional outcome in young children. Modifications of the scale for pediatric populations have been shown to be useful in assessing outcome [20, 21, 22]. Studies typically restrict poor outcome on the GOS to children who are severely disabled or are in a persistent vegetative state.…”

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy

“…Other determinants of outcome from previous reports have included the severity of the early posttraumatic seizures, lower cerebral perfusion pressures, and the extent of parenchymal injuries on computed tomography during the acute encephalopathy. 13,14,37,38 The postinjury environment influences outcome from a TBI; this has been found in both in humans and in animals, where it has been demonstrated that environmental enrichment improves the recovery in rats. 39,40 In this study, the speech and language development in 1 patient was shown to improve markedly after a change of major caregiver.…”

“…One prospective study of 28 children reported that 16% had a severe outcome, 61% had a moderate outcome, and 25% had a good outcome at a mean follow-up of 3 months. 14 The overall morbidity in reports of a total of 292 survivors is 74% (range: 59 -100%), with only 25% being "normal" on follow-up. 7 No long-term follow-up studies have reported the outcome of the whole spectrum of inflicted TBI.…”

Cerebrospinal Fluid Levels of High-Mobility Group Box 1 and Cytochrome C Predict Outcome after Pediatric Traumatic Brain Injury

“…5B), suggesting different cell death pathways detected among patients with accidental TBI and AHT. AHT has been commonly associated with poor outcome, and several clinical aspects differ significantly from children presenting with accidental TBI (Ewing-Cobbs et al, 1999;Keenan et al, 2004). AHT patients are younger than accidental TBI patients, primarily consisting of infants or toddlers.…”