Outcomes following childhood head injury: a population study

Abstract

Objectives: To identify outcomes following head injury (HI) among a population of children admitted to one hospital centre and to compare outcomes between different severity groups. Methods: A postal follow up of children admitted with HI to one National Health Service Trust, between 1992 and 1998, was carried out. Children were aged 5-15 years at injury (mean 9.8), followed up at a mean of 2.2 years post-injury. Parents of 526 injured children (419 mild, 58 moderate, 49 severe) and 45 controls completed questionnaires. Outcomes were assessed using the King's Outcome Scale for Childhood Head Injury (KOSCHI). Results: Frequent behavioural, emotional, memory, and attention problems were reported by one third of the severe group, one quarter of the moderate, and 10-18% of the mild. Personality change since HI was reported for 148 children (28%; 21% mild HI, 46% moderate, 69% severe). There was a significant relationship between injury severity and KOSCHI outcomes. Following the HI, 252 (48%) had moderate disability (43% mild HI, 64% moderate, 69% severe), while 270 (51%) made a good recovery (57% mild HI, 36% moderate, 22% severe). There was a significant association between social deprivation and poor outcome (p = 0.002). Only 30% (158) of children received hospital follow up after the HI. All children with severe disability received appropriate follow up, but 64% of children with moderate disability received none. No evidence was found to suggest a threshold of injury severity below which the risk of late sequelae could be safely discounted. Conclusions: Children admitted with mild HI may be at risk of poor outcomes, but often do not receive routine hospital follow up. A postal questionnaire combined with the KOSCHI to assess outcomes after HI may be used to identify children who would benefit from clinical assessment. Further research is needed to identify factors that place children with mild HI at risk of late morbidity.

The King's Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury

“…27 They showed a strong correlation between KOSCHI and injury severity, categorized according to the GCS and/or duration of loss of consciousness into mild, moderate, or severe groups. Our results similarly show strong relations between KOSCHI category at hospital discharge and a range of measures of injury severity, namely GCS, length of hospital stay, and PTA.…”

A Combined Therapeutic Regimen of Buspirone and Environmental Enrichment Is More Efficacious than Either Alone in Enhancing Spatial Learning in Brain-Injured Pediatric Rats

“…[15][16][17] Buspirone has been reported to increase dopamine (DA) levels in regions considered essential for cognitive processing such as the prefrontal cortex and hippocampus. 15,48 In addition, numerous studies have shown that DA neurotransmission is important for spatial learning and memory (for excellent reviews, see [10][11][12][13] ). Another potential mechanism may be neuroprotection or restoration of the cholinergic system as evidenced by data showing that 8-OH-DPAT reduced the TBI-induced loss of choline acetyltransferase-positive medial septal cells, which correlated with improved cognitive performance.…”

“…[6][7][8] Of the surviving children, it is estimated that approximately half exhibit physical, cognitive, and/or psychosocial deficits. [8][9][10] Because of the devastating consequences induced by TBI in a population that could be negatively affected for decades, studies that focus on functional recovery after pediatric TBI are critical.…”

Clinical use of the Mayo‐Portland Adaptability Inventory in rehabilitation after paediatric acquired brain injury

“…It can, therefore, fail to differentiate between those who are making rehabilitation progress and those who are not. The King's Outcome Scale for Childhood Head Injury (KOSCHI) 18,19 expands on the GOS approach with better coverage for mild head injury. It differs from the MPAI in two fundamental respects.…”