A prospective study of children with head injuries: II. Cognitive sequelae

1981 ◽  
Vol 11 (1) ◽  
pp. 49-61 ◽  
Author(s):  
Oliver Chadwick ◽  
Michael Rutter ◽  
Gillian Brown ◽  
David Shaffer ◽  
Michael Traub
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Reading Ability ◽  
Head Injuries ◽  
Specific Pattern ◽  
Control Group ◽  
Severe Injuries ◽  
Injury Group ◽  
Severity Of Injury ◽  
Cognitive Sequelae

SYNOPSISA 2¼-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a PTA exceeding 1 hour but less than 1 week. Individual psychological testing was carried out as soon as the child recovered from PTA, and then again 4 months, 1 year, and 2¼ years after the injury. A shortened version of the Wechsler Intelligence Scale for Children (WISC), the Neale Analysis of Reading Ability and a battery of tests of specific cognitive functions were employed. The mild head injury group had a mean level of cognitive functioning below the control group, but the lack of any recovery during the follow-up period indicated that the intellectual impairment was not a consequence of the injury. In the severe head injury group, the presence of cognitive recovery and a ‘dose—response’ relationship with the degree of brain injury showed that the intellectual deficits were caused by brain damage. Some degree of cognitive impairment was common following head injuries giving rise to a PTA of at least 2 weeks. Conversely no cognitive sequelae, transient or persistent, could be detected when the PTA was less than 24 hours. The results were less consistent in the 1-day to 2-week PTA range, but the evidence suggested that a broadly defined threshold for impairment operated at about that level of severity of injury. Timed measures of visuo-spatial and visuo-motor skills tended to show more impairment than verbal skills but otherwise there was no suggestion of a specific pattern of cognitive deficit. Recovery was most rapid in the early months after injury, but substantial recovery continued for 1 year with some improvement continuing in the second year in some children, especially those with the most severe injuries. Age, sex and social class showed no significant effects on the course of recovery.

A prospective study of children with head injuries: I. Design and methods

1980 ◽  
Vol 10 (4) ◽  
pp. 633-645 ◽  
Author(s):  
Michael Rutter ◽  
Oliver Chadwick ◽  
David Shaffer ◽  
Gillian Brown
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Reading Ability ◽  
School Teacher ◽  
Head Injuries ◽  
Control Group ◽  
Physical Handicap ◽  
Traumatic Amnesia ◽  
Post Traumatic ◽  
A Prospective Study

SYNOPSISThe main unresolved issues with respect to the psychological sequelae of brain damage in childhood are noted, and the previous studies of children suffering head injury are critically reviewed. A new prospective study is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a post-traumatic amnesia exceeding 1 hour but less than 1 week. The children were studied as soon as possible after the accident and then again 4 months, 1 year, and 2¼ years after the injury. The parents were interviewed, using systematic and standardized interview techniques; both parents and teachers completed behavioural questionnaires; and the children were seen for individual psychological testing using the WISC, the Neale Analysis of Reading Ability and a battery of tests of more specific cognitive functions. At the final follow-up, the severe head injury group (but not the other 2 groups) received a systematic neurological examination and the school teacher who knew the child best was personally interviewed. The findings are given on physical handicap, neurological abnormality, school placement and psychiatric referrals. All types of disabilities were both more frequent and more persistent in the children with severe head injuries.

A prospective study of children with head injures: III. Psychiatric sequelae

1981 ◽  
Vol 11 (1) ◽  
pp. 63-78 ◽  
Author(s):  
Gillian Brown ◽  
Oliver Chadwick ◽  
David Shaffer ◽  
Michael Rutter ◽  
Michael Traub
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Psychiatric Disorders ◽  
Head Injuries ◽  
High Rate ◽  
Control Group ◽  
Retrospective Assessment ◽  
Injury Group ◽  
Initial Injury ◽  
A Prospective Study

SYNOPSISA 2¼-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a PTA exceeding 1 hour but less than 1 week. A retrospective assessment of the children's pre-accident behaviour was obtained by parental interview and teacher questionnaire immediately after the accident and before the behavioural sequelae of the injury could be known. Further psychiatric assessments were undertaken 4 months, 1 year and 21 years after the initial injury. The mild head injury group showed a raised level of behavioural disturbance before the accident but no increase thereafter. It was concluded that head injuries resulting in a PTA of less than I week did not appreciably increase the psychiatric risk. By contrast, there was a marked increase in psychiatric disorders following severe head injury. The high rate of new disorders in children with severe head injuries who were without disorder before the accident, together with the finding of a dose–response relationship with the severity of brain injury, indicated a causal relationship. However, the development of psychiatric disorders in children with severe head injuries was also influenced by the children's pre-accident behaviour, their intellectual level, and their psychosocial circumstances. With the exception of social disinhibition and a slight tendency for the disorders to show greater persistence over time, the disorders attributable to head injury showed no specific features.

scholarly journals Outcome of Head Injury Patients Undergoing Surgical Management: A Tertiary Level Experience

2012 ◽  
Vol 9 (4) ◽  
pp. 283-285
Author(s):  
A Shrestha ◽  
R M Joshi ◽  
A Thapa ◽  
U P Devkota ◽  
D N Gongal
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Surgical Intervention ◽  
Head Injuries ◽  
Glasgow Outcome Score ◽  
Injury Mortality ◽  
Outcome Score ◽  
Injury Group ◽  
Neurosurgical Patient ◽  
Severity Of Injury

Background Head injury is the major cause of death in a neurosurgical patient. Objective To find the outcome, and treatment modality affecting the outcome in patients with head injury. Methods Nine hundred eighty seven patients presenting to National Institute of Neurological and Allied Sciences, Kathmandu, with head injury from September 2009 to October 2010 were included in the study. Patients were categorized according to post resuscitation Glasgow Coma Score. Outcome was assessed at discharge using Glasgow Outcome Score and analyzed for any correlation with modality of treatment and severity of injury. Results Among 987 patients with head injury,152 (15.4%) had severe, 126 (12.8%) had moderate and 709 (71.8%) had mild head injuries. Three hundred twelve (31.6%) patients required definitive and supportive surgical intervention. One hundred eighty two required cranial surgical intervention. Overall mortality was 10% (99), 137 patients (13.9%) had unfavorable outcome and 850 (86.1%) had favorable Glasgow Outcome Score of 4 and 5. Mortality was 53.2%, 9.5% and 0.8% in severe, moderate and mild head injury group respectively. Mortality rate was significantly higher (64.6%) in severe head injury group managed conservatively than those in same group treated with supportive and definite surgical intervention (44.8%) (p=0.016). Conclusion Mortality in head injury patients depend upon severity of injury. Mortality in severe head injury group can be reduced by supportive and definite surgical intervention.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6345 Kathmandu Univ Med J 2011;9(4):283-5

Moderate Head Injury: Completing the Clinical Spectrum of Brain Trauma

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 344-351 ◽  
Author(s):  
Rebecca W. Rimel ◽  
Bruno Giordani ◽  
Jeffrey T. Barth ◽  
John A. Jane
Keyword(s):  
Head Injury ◽  
Present Report ◽  
Economic Status ◽  
Head Injuries ◽  
Ct Scanning ◽  
Minor Head Injury ◽  
Good Recovery ◽  
Severe Injuries ◽  
Computed Tomographic ◽  
Severity Of Injury

Abstract We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3–8; moderate, 9–12; and minor, 13–15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow–up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy–five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space–occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90% difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead–Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty–six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio–economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis. GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and (c) more attention should be directed to patients with moderate head injury than to those with the most severe injuries, in whom brain damage is probably irreversible and all forms of management have demonstrated little success.

Head injury mortality in two centers with different emergency medical services and intensive care

1989 ◽  
Vol 71 (2) ◽  
pp. 202-207 ◽  
Author(s):  
Austin R. T. Colohan ◽  
Wayne M. Alves ◽  
Cynthia R. Gross ◽  
James C. Torner ◽  
V. S. Mehta ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Head Injuries ◽  
Mortality Rates ◽  
Striking Similarity ◽  
Prehospital Emergency Care ◽  
New Delhi ◽  
Severe Injuries ◽  
Content Type ◽  
Severity Of Injury

✓ The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p < 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p < 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with “moderate” head injuries.

Mechanisms and consequences of head injuries in soccer: a study of 451 patients

2011 ◽  
Vol 31 (5) ◽  
pp. E1 ◽  
Author(s):  
Malgorzata A. Kolodziej ◽  
Stephan Koblitz ◽  
Christopher Nimsky ◽  
Dieter Hellwig
Keyword(s):  
Head Injury ◽  
Head Injuries ◽  
Body Part ◽  
Physical Symptoms ◽  
The Body ◽  
Control Group ◽  
Case Group ◽  
Body Parts ◽  
Injury Group ◽  
Complicated Course

Object The goal of this study was to evaluate the incidence and mechanisms of head injury during soccer games and to describe the results after spontaneous resolution of symptoms or after treatment. Methods In a retrospective study from 2005, records on 451 players from the German Soccer Association who had suffered various injuries were collected. The study used a questionnaire in which the player described the accident and the playing situation as well as the clinical course after trauma. This questionnaire also included information about the physical symptoms of the players and the length of their rehabilitation. Two groups were formed: one with head injuries (case group), and the other with injuries of other body parts (control group). Results Of the injuries reported, 108 (23.9%) were related to the head, 114 (25.3%) to the knee, 58 (13%) to the ankle, 56 (12%) to the calf, and 30 (7%) to the shoulder. The areas of the head most frequently involved were the facial and occipital regions. In the head injury group, the head duel was the most common playing action to lead to trauma. In those cases, the body part that hit the injured player was the elbow, arm, or head of the opponent. The most common playing situation was combat in the penalty area. The median hospitalization time after the trauma was 2 days for the case group and 5 days for the control group. The rehabilitation time for the case group was also shorter (median 6.5 days) than for the control group (median 30 days). Conclusions Trivial head injuries in soccer can have a long and complicated course. Nevertheless, the temporary disability is shorter in most cases than for players with injuries to other parts of the body. Modifying the rules of play would be necessary to reduce the incidence of head trauma.

Antidepressants Not Effective in Headache Associated with Minor Closed Head Injury

1989 ◽  
Vol 18 (1) ◽  
pp. 75-83 ◽  
Author(s):  
Avtar Saran
Keyword(s):  
Head Injury ◽  
Muscle Contraction ◽  
No Reduction ◽  
Closed Head Injury ◽  
Control Group ◽  
Depression Group ◽  
Injury Group ◽  
Closed Head

The author compared the response to amitriptyline in headache associated with depression between twelve patients having primary depression (control group) and ten patients with depression after minor closed head injury. In the primary depression group, there was significant reduction in headache and improvement in depression. The minor closed head injury group did not show significant reduction in headache or improvement in depression. The latter group, upon further treatment with phenelzine also showed no reduction in headache or improvement in depression. Results of this study question the earlier reports of the usefulness of amitriptyline in chronic muscle contraction headache and depression associated with minor closed head injury.

Cause of decline in head-injury mortality rate in San Diego County, California

1985 ◽  
Vol 62 (4) ◽  
pp. 528-531 ◽  
Author(s):  
Melville R. Klauber ◽  
Lawrence F. Marshall ◽  
Belinda M. Toole ◽  
Sharen L. Knowlton ◽  
Sharon A. Bowers
Keyword(s):  
Head Injury ◽  
San Diego ◽  
Head Injuries ◽  
Mortality Rates ◽  
San Diego County ◽  
Content Type ◽  
Severity Of Injury ◽  
Prehospital Emergency ◽  
Injured Patients ◽  
Number Of Individuals

✓ Even with an increasing population, there were 100 fewer deaths due to head injury in San Diego County, California, in 1982 compared to 1980. During the 5 years from 1976 to 1980 there was nearly a constant death rate from head injuries, followed in the next 2 years by a decline of 24%. The number of deaths at the scene of injury declined 28%, and the number of individuals listed as dead on arrival at the hospital declined 68%. Mortality rates in the emergency room increased slightly and later death rates declined slightly. Mortality rates of hospitalized patients, adjusted for severity of injury, did not vary materially by year. This decline in deaths due to head injury followed a marked improvement in the county's emergency ground and prehospital air evacuation services. The data strongly suggest that advanced prehospital emergency medical services can substantially reduce mortality rates in head-injured patients. The authors postulate that some patients who ordinarily “would die now talk” because of early airway and circulatory management by highly trained paramedical personnel and airborne trauma specialists. Despite a search for other factors that might explain these observations, no satisfactory alternatives could be identified.

Treatment of head injuries in the American Civil War

1993 ◽  
Vol 78 (5) ◽  
pp. 838-845 ◽  
Author(s):  
Howard H. Kaufman
Keyword(s):  
Civil War ◽  
Head Injury ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Gunshot Wounds ◽  
American Civil War ◽  
Content Type ◽  
Severity Of Injury ◽  
Surgical History ◽  
Fine Print

✓ At the time of the American Civil War (1861–1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons. The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.

Moderate head injury: a guide to initial management

1992 ◽  
Vol 77 (4) ◽  
pp. 562-564 ◽  
Author(s):  
Sherman C. Stein ◽  
Steven E. Ross
Keyword(s):  
Head Injury ◽  
Head Injuries ◽  
Ct Scanning ◽  
Ct Scans ◽  
Initial Examination ◽  
Content Type ◽  
Injury Group ◽  
Intracranial Lesions ◽  
Gcs Score ◽  
Fine Print

✓ The purpose of this study is to determine the initial treatment of patients who appear to have sustained moderate head injuries when first evaluated. The authors reviewed the records of 341 patients whose initial Glasgow Coma Scale (GCS) scores ranged from 9 to 12, as well as another 106 patients with GCS scores of 13. All patients underwent cranial computerized tomography (CT) at the time of admission. In 40.3% of these patients the CT scans were abnormal (30.6% had intracranial lesions), and 8.1 % required neurosurgical intervention (craniotomies for hematoma in 12, elevation of depressed fractures in five, and insertion of intracranial pressure monitors in 19). Four patients died of their intracranial injuries. A similar incidence of lesions found on CT and at surgery suggests that an initial GCS score of 13 be classified with the moderate head injury group. Skull fractures were found to be poor indicators of intracranial abnormalities. These results suggest that all patients with head injury thought to be moderate on initial examination be admitted to the hospital and undergo urgent CT scanning. Patients with intracranial lesions require immediate neurosurgical consultation, surgery as needed, and admission to a critical-care unit. Scans should be repeated in patients whose recovery is less rapid than expected and in all patients with evidence of clinical deterioration; this was necessary in almost half of the patients in this group, and 32% were found to have progression of radiological abnormalities on serial CT scans.

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