Retrospective Study on the Pathway and the Outcome of Children Victims of Acquired Brain Injury Accompanied By a Mobile Unit of School Reintegration

Abstract

Objectives: to retrace the care pathways and the academic pathways of brain-damaged children supported a Mobile Unit of School Reintegration (MUSR) and to identify factors associated with their long-term outcome. Patients and methods: Retrospective study from the medical files of 53 children followed by the MUSR, conducted between November 2018 and April 2019. Results: The cerebro-lesions were mainly caused by a craniocerebral trauma (83% of cases), with an average age of onset of 9.8 years. The duration of the initial hospitalization was 39 days on average. The mean length of follow-up was 37 months. Long-term medical outcome was marked by 18.5% of medical complications, 29.6% of behavioral disorders and 9.2% of judiciary complications. The factors associated with long-term behavioral disorders were the age of onset (p = 0.015), the initial Glasgow score (p = 0.025), a head trauma related to a traffic accident (p = 0.046), a poor therapeutic alliance with the parents (p <0.001), the absence of psychological follow-up (p = 0.040) and the existence of legal complications (p = 0.001). The factor associated with long-term legal complications was a poor therapeutic alliance with the parents (p = 0.017). All the children followed were reintegrated into school, after an average of 6.4 months. A school reorientation was necessary in 49.9% of cases, associated with initial complications (p = 0.035), the existence of secondary brain aggressions of systemic origin (p <0.001), the existence of antecedents (p = 0.040), and the autonomy level (p = 0.023). Conclusion: The MUSR offers multidisciplinary, integrative and mobile cares, based on coordination of the care pathway and the academic pathway of children victims of acquired brain injuries.