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

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

Psychological Medicine ◽

10.1017/s0033291700053277 ◽

1981 ◽

Vol 11 (1) ◽

pp. 49-61 ◽

Cited By ~ 171

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.

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

Psychological Medicine ◽

10.1017/s0033291700054933 ◽

1980 ◽

Vol 10 (4) ◽

pp. 633-645 ◽

Cited By ~ 79

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.

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Head Injury Admissions to a Teaching Hospital

Scottish Medical Journal ◽

10.1177/003693307702200208 ◽

1977 ◽

Vol 22 (2) ◽

pp. 129-132 ◽

Cited By ~ 16

Author(s):

S. Galbraith ◽

W. R. Murray ◽

A. R. Patel

Keyword(s):

Head Injury ◽

Prospective Study ◽

Teaching Hospital ◽

Head Injuries ◽

Emergency Admissions ◽

One Year ◽

A Prospective Study ◽

Overall Mortality

A prospective study of head injury admissions to a city teaching hospital over one year has shown that most were minor. Of the 918 patients, 85 per cent were discharged within 48 hours, only 3 per cent required definitive neurosurgical care, and the overall mortality was 2 per cent. Most cases came to hospital after 5.00 p.m. especially at the weekend. Head injuries accounted for almost one-third of emergency admissions to male general surgical wards.

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

Neurosurgical FOCUS ◽

10.3171/2011.10.focus11184 ◽

2011 ◽

Vol 31 (5) ◽

pp. E1 ◽

Cited By ~ 7

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.

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Serum Concentration of Myelin Basic Protein as a Prognostic Marker in Mild-to-moderate Head Injury Patients: A Prospective Study in a Tertiary Care Center

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1716936 ◽

2021 ◽

Author(s):

Ashvamedh Singh ◽

Kulwant Singh ◽

Anurag Sahu ◽

R. S. Prasad ◽

N. Pandey ◽

...

Keyword(s):

Head Injury ◽

Prospective Study ◽

Myelin Basic Protein ◽

Prognostic Marker ◽

Outcome Prediction ◽

Basic Protein ◽

Care Center ◽

Tertiary Care ◽

Gcs Score ◽

A Prospective Study

Abstract Objective To estimate the level of myelin basic protein (MBP) and look for its validity in outcome prediction among mild-to-moderate head injury patients. Materials and Methods It was a prospective study done at the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University from Jan 2018 to July 2019. All patients who presented to us within 48 hours of injury with mild-to-moderate head injury with apparently normal CT brain were include in the study. The serum sample were collected on the day of admission and 48 hours later, and patients were treated with standard protocols and observed 6 months postdischarge. Results Of the 32 patients enrolled, we observed mean MBP level was higher for severity of brain damage, but not associated with age, mode of injury, and radiological diagnosis. Mean MBP levels were not statistically associated with Glasgow coma scale (GCS) score at admission but was correlated to outcome with p < 0.05, with sensitivity of 50% and specificity 72%, that is, patients with good outcome have lower mean MBP levels. Conclusion MBP as per our analysis can be used as a prognostic marker in patients with head injury. It is not the absolute value rather a trend showing rise in serum MBP levels, which carries a significant value in outcome prediction.

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Role of routine fluid replacement in children undergoing tonsillectomy

The Journal of Laryngology & Otology ◽

10.1017/s0022215100113933 ◽

1990 ◽

Vol 104 (10) ◽

pp. 801-802 ◽

Cited By ~ 4

Author(s):

P. S. Wilson ◽

D. G. Snow ◽

J. O'Connel ◽

D. W. Proops ◽

M. Barrow

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Intravenous Infusion ◽

Intravenous Fluid ◽

Fluid Replacement ◽

Control Group ◽

A Prospective Study ◽

To Receive

AbstractIt has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operativefasting combined with the blood loss at operation.A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group.There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay.There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.

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Delayed Homicides Due to Infant Head Injury Initially Reported as Natural (Cerebral Palsy) Deaths

Pediatric and Developmental Pathology ◽

10.2350/07-02-0236.1 ◽

2008 ◽

Vol 11 (1) ◽

pp. 39-45 ◽

Cited By ~ 11

Author(s):

James R. Gill ◽

Raffaella A. Morotti ◽

Vincent Tranchida ◽

Jacquelyn Morhaime ◽

Hernando Mena

Keyword(s):

New York ◽

Cerebral Palsy ◽

Head Injury ◽

Head Injuries ◽

Border Zone ◽

Traumatic Head Injury ◽

Manner Of Death ◽

Proximate Cause ◽

Delayed Effects ◽

Initial Injury

A spectrum of neuropathology occurs in infants who sustain traumatic brain injury. Because of a prolonged survival interval, there is a risk that these deaths may not be recognized as a sequel of trauma. We reviewed the records in New York City of 5 delayed fatalities due to nonaccidental infant head injury that had survival intervals from 2.5 to 17 years. The head injuries occurred at 2 to 3 months of age, and death occurred at 2.5 to 17 years of age. Initially, they were reported as natural deaths by treating physicians, families, and/or police. All 5 infants had unexplained or poorly explained remote traumatic head injury that included subdural hematomas. At autopsy, the neuropathologic exam demonstrated remote subdural hemorrhages and lesions related to chronic hypoxic-ischemic injury including atrophy, arterial infarcts, border-zone infarcts, and cystic encephalomalacia. Each child survived the initial injury but later succumbed to the delayed effects of secondary hypoxic-ischemic encephalopathy. These 5 deaths highlight the need to investigate independently the medical history of any child (or adult) who dies with a clinical diagnosis of “cerebral palsy.” The term cerebral palsy often is used as a catchall for any patient who has had neurologic impairment since infancy or childhood. If there is a direct link between the initial injury and the death, even if the injury occurred many years before death, then the injury is the proximate cause of death and dictates the manner of death. All 5 deaths were certified as homicides.

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A clinicoradiological scoring for management of acute subdural hematoma: a prospective study

Romanian Neurosurgery ◽

10.2478/romneu-2018-0045 ◽

2018 ◽

Vol 32 (2) ◽

pp. 359-365

Author(s):

Sachidanand Gautam ◽

Anubhav Sharma ◽

S.C. Dulara

Keyword(s):

Prospective Study ◽

Subdural Hematoma ◽

Scoring System ◽

Head Injuries ◽

Postoperative Outcome ◽

Clinical History ◽

Acute Subdural Hematoma ◽

Subdural Hemorrhage ◽

Male Predominance ◽

A Prospective Study

Abstract Background: Acute subdural hematoma is the most common type of traumatic intra cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The aim of this study is to analyze the prognostic factors and to propose Neuro-clinical and radiological prognostic scoring system on the clinical spectrum and to evaluate the postoperative outcome and validate the same. Methods: This is a prospective Study which included 100 patients admitted in Government Medical College, Kota, Rajasthan from 01st Jan 2016 to 30 June 2017 with head injury and were diagnosed to have Traumatic Subdural Hemorrhage. A detailed clinical history, Physical examination, Computerized Tomography scan was performed in all patients and were divided into 2 groups; that is conservative or surgical interventional as per Neuro-clinical and radiological prognostic scoring system. Results: The maximum patients suffering from Subdural Hematoma were in the age group of 11-60 years with male predominance 72%. The most common mode of injury was RTA with 68 % of incidence. 36 out of 100 cases presented to hospital with GCS <8 while 44 patients showed improvement of GCS after resuscitation. Out of 100 cases, surgical approach was considered in 34 patients while remaining patients were managed conservatively. Pupillary reaction, Hypotension, CT scan findings that is, thickness of hematoma >10mm and midline shift of >5mm, delay in interval between the surgery had greatly affected on outcome of patients. Conclusions: According to the results, use of Neuro-clinical and radiological prognostic scoring system is very useful in determining early intervention and also avoids unnecessary surgical intervention.

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Epistaxis as a marker for severe acute respiratory syndrome coronavirus-2 status – a prospective study

The Journal of Laryngology & Otology ◽

10.1017/s0022215120001863 ◽

2020 ◽

Vol 134 (8) ◽

pp. 717-720 ◽

Cited By ~ 1

Author(s):

MH Hussain ◽

M Mair ◽

P Rea

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Prospective Study ◽

Control Group ◽

Study Group ◽

Chain Reaction ◽

Polymerase Chain Reaction Testing ◽

The Mean ◽

Polymerase Chain ◽

The Difference ◽

A Prospective Study

AbstractObjectiveTo evaluate the prevalence of severe acute respiratory syndrome coronavirus-2 infection in patients presenting with epistaxis to a tertiary otolaryngology unit.MethodsA prospective study was conducted of 40 consecutive patients presenting with epistaxis referred to our tertiary otolaryngology unit. A group of 40 age-matched controls were also included. All patients underwent real-time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus-2. Symptoms of fever, cough and anosmia were noted in the study group.ResultsThe mean age was 66.5 ± 22.4 years in the study group. There were 22 males (55 per cent) and 18 females (45 per cent). The mean age in the control group was 66.3 ± 22.4 years (p = 0.935). There were six positive cases for severe acute respiratory syndrome coronavirus-2 (15 per cent) in the epistaxis group and one case (2.5 per cent) in the control group. The difference was statistically significant (p = 0.05).ConclusionEpistaxis may represent a presenting symptom of severe acute respiratory syndrome coronavirus-2 infection. This may serve as a useful additional criterion for screening patients.

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