Functional Outcome After Pediatric Head Injury

PEDIATRICS ◽  
1994 ◽  
Vol 94 (4) ◽  
pp. 425-432
Author(s):  
Arlene I. Greenspan ◽  
Ellen J. MacKenzie
Keyword(s):  
Head Injury ◽  
Social Services ◽  
Behavioral Problems ◽  
Injury Severity ◽  
Functional Limitations ◽  
Head Injuries ◽  
Sociodemographic Factors ◽  
Abbreviated Injury Scale ◽  
Severe Injuries ◽  
Head Injury Severity

Objectives. To examine the consequences of head injury and the medical, economic, and sociodemographic factors affecting functional status 1 year after injury. Methods. A follow-up was conducted on 95 children (aged 5 to 15) 1 year after they were hospitalized for head injury. Parents were interviewed by phone concerning their child's preinjury and current health status, and the family's economic and social resources during the 1 year postinjury. Inpatient medical records were reviewed to obtain information regarding the characteristics of the injury. Results. We found that study children were more likely than children from the general population to have limitations in physical health, behavioral problems, and to be enrolled in a special education program. These findings were true for all levels of head injury severity, although children with severe head injuries (Abbreviated Injury Scale 5) were more likely to demonstrate these functional limitations than were children with less severe injuries (Abbreviated Injury Scale 2, 3, 4). After controlling for head injury severity, we found that the poorer outcomes were associated with poverty, preinjury chronic health problems, and lower extremity injuries. Conclusions. The large proportion of children who demonstrated functional limitations underscores the importance of evaluating all children hospitalized with head injuries for functional limitations and providing rehabilitation and social services when needed.

The impact of posttraumatic seizures on 1-year neuropsychological and psychosocial outcome of head injury

1996 ◽  
Vol 2 (6) ◽  
pp. 494-504 ◽  
Author(s):  
Alan M. Haltiner ◽  
Nancy R. Temkin ◽  
H. Richard Winn ◽  
Sureyya S. Dikmen
Keyword(s):  
Head Injury ◽  
Psychosocial Functioning ◽  
Brain Injuries ◽  
Injury Severity ◽  
Head Injuries ◽  
Psychosocial Outcome ◽  
Traumatic Head Injury ◽  
The Impact ◽  
Head Injury Severity ◽  
Posttraumatic Seizures

AbstractThis study examined the relationship of posttraumatic seizures and head injury severity to neuropsychological performance and psychosocial functioning in 210 adults who were prospectively followed and assessed 1 year after moderate to severe traumatic head injury. Eighteen percent (n = 38) of the patients experienced 1 or more late seizures (i.e., seizures occurring 8 or more days posttrauma) by the time of the 1-year followup. As expected, the head injured patients who experienced late posttraumatic seizures were those with the most severe head injuries, and they were significantly more impaired on the neuropsychological and psychosocial measures compared to those who remained seizure free. However, after the effects of head injury severity were controlled, there were no significant differences in neuropsychological and psychosocial outcome at 1 year as a function of having seizures. These findings suggest that worse outcomes in patients who develop posttraumatic seizures up to 1 year posttrauma largely reflect the effects of the brain injuries that cause seizures, rather than the effect of seizures. (JINS, 1996, 2, 494–504.)

An Analysis of Beta-Blocker Administration Pre-and Post-Traumatic Brain Injury with Subanalyses for Head Injury Severity and Myocardial Injury

2016 ◽  
Vol 82 (12) ◽  
pp. 1203-1208 ◽  
Author(s):  
Mathew Edavettal ◽  
Brian W. Gross ◽  
Katelyn Rittenhouse ◽  
James Alzate ◽  
Amelia Rogers ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Beta Blocker ◽  
Myocardial Injury ◽  
Injury Severity ◽  
Multivariate Analyses ◽  
Beta Blockers ◽  
Abbreviated Injury Scale ◽  
Head Injury Severity

A growing body of literature indicates that beta-blocker administration after traumatic brain injury (TBI) is cerebroprotective, limiting secondary injury; however, the effects of preinjury beta blocker status remain poorly understood. We sought to characterize the effects of pre- and post-injury beta-blocker administration on mortality with subanalyses accounting for head injury severity and myocardial injury. In a Level II trauma center, all admissions of patients ≥18 years with a head Abbreviated Injury Scale Score ≥2, Glasgow Coma Scale ≤13 from May 2011 to May 2013 were queried. Demographic, injury-specific, and outcome variables were analyzed using univariate analyses. Subsequent multivariate analyses were conducted to determine adjusted odds of mortality for beta-blocker usage controlling for age, Injury Severity Score, head Abbreviated Injury Scale, arrival Glasgow Coma Scale, ventilator use, and intensive care unit stay. A total of 214 trauma admissions met inclusion criteria: 112 patients had neither pre- nor postinjury beta-blocker usage, 46 patients had preinjury beta-blocker usage, and 94 patients had postinjury beta-blocker usage. Both unadjusted and adjusted odds ratios of preinjury beta-blocker were insignificant with respect to mortality. However, postinjury in-hospital administration of beta blockers was found to significantly in the decrease of mortality in both univariate ( P = 0.002) and multivariate analyses ( P = 0.001). Our data indicate that beta-blocker administration post-TBI in hospital reduces odds of mortality; however, preinjury beta-blocker usage does not. Additionally, myocardial injury is a useful indicator for beta-blocker administration post-TBI. Further research into which beta blockers confer the best benefits as well as the optimal period of beta-blocker administration post-TBI is recommended.

One year psychosocial outcome in head injury

1995 ◽  
Vol 1 (1) ◽  
pp. 67-77 ◽  
Author(s):  
Sureyya S. Dikmen ◽  
Barbara L. Ross ◽  
Joan E. Machamer ◽  
Nancy R. Temkin
Keyword(s):  
Head Injury ◽  
Low Income ◽  
Injury Severity ◽  
Sickness Impact Profile ◽  
Head Injuries ◽  
Psychosocial Outcome ◽  
Post Injury ◽  
Head Injured ◽  
One Year ◽  
Head Injury Severity

AbstractPsychosocial outcome at one year post-injury was examined prospectively in 466 hospitalized head-injured subjects, 124 trauma controls, and 88 friend controls. The results indicate that head injury is associated with persistent psychosocial limitations. However, the presence and extent of limitations are related to the demographics of the population injured, to other system injuries sustained in the same accident, and particularly to the severity of the head injury. More severe head injuries are associated with limitations implying greater dependence on others including poorer Glasgow Outcome Scale (GOS) ratings, dependent living, unemployment, low income, and reliance on family and social subsidy systems. Head injury severity is more closely related to more objective indices of psychosocial outcome (e.g., employment) than to self-perceived psychosocial limitations, such as measured by the Sickness Impact Profile (SIP). (JINS, 1995, I, 67–77.)

Skateboard Injuries

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 611-612
Author(s):  
Keyword(s):  
Head Injury ◽  
Head And Neck ◽  
Injury Severity ◽  
Bone Fractures ◽  
Head Injuries ◽  
The United States ◽  
Motor Vehicles ◽  
Long Bone ◽  
Consumer Product Safety Commission ◽  
Severe Injuries

Skateboarding has resurged and so have its associated hazards and injuries. There are an estimated 8 million skateboarders now in the United States.1 Pediatricians informed about skateboard activities in their areas can help prevent needless injuries to children and adolescents. During the last skateboard injury epidemic, the annual incidence of injuries peaked at 150 000 in 1977 and subsequently decreased to 16 000 in 1983. It is likely that this decrease in injuries was primarily related to decreased skateboard activity and not to improved safety conditions. With increased popularity the number has risen, with an estimated 56 435 injuries being treated in emergency departments in 1992.1 In addition, an estimated 1900 hospitalizations occurred due to skateboard-related injuries during this period. The vast proportion of admissions were from head injuries.2 Analysis of Consumer Product Safety Commission data from 1991 indicates the following salient features of the current outbreak of skateboard injuries during this period3: • 95% involved skateboarders younger than 25 years; 61% involved 5- to 14-year-olds; • 87% of victims were male; • 74% of injuries involved the extremities—usually fractures of radius and ulna, 21% to the head and neck, and 5% to the trunk; • severe injuries (intracranial, internal) were uncommon, moderate injuries (long bone fractures) were most common, and deaths occurred almost always from collisions with motor vehicles; • younger victims incurred a higher proportion of head and neck injuries than older victims—head injury occurred in 75% of the victims in the 0- to 4-year-old age group, 50% in the 5- to 9-year-old group, and 15% in the 10- to 19-year-old category; • head injuries in the older age groups were more severe because of collisions with motor vehicles; and • helmets designed for skateboarding are seldom worn but will protect skateboarders from serious head injury; data on the protective value of elbow pads, knee pads, and wrist guards are inconclusive; they may reduce injury severity. The use of bicycle or hockey helmets has not been evaluated.4,5

Pediatric Head Injuries in Summer Camps

2020 ◽  
Vol 59 (4-5) ◽  
pp. 369-374
Author(s):  
Kristen Kolberg ◽  
Noor Saleem ◽  
Michael Ambrose ◽  
Jim Cranford ◽  
Andrea Almeida ◽  
...  
Keyword(s):  
Head Injury ◽  
Injury Risk ◽  
Injury Severity ◽  
Head Injuries ◽  
Summer Camps ◽  
Safe Environment ◽  
Head Injury Severity

Summer camps have a unique supervisory environment that may lead to increased head injury risk for children. The epidemiology of head injuries in camps is unclear. We partnered with CampDoc.com to review head injury reports from camp nurses in 2016 from 197 camps in 36 states. A total of 4290 (92%) reports were coded as definite head injuries, 47% (n = 2002) in female campers, with median camper age of 10 years. Head injury severity was coded as mild (94%, n = 4040), moderate (6%, n = 248), or severe (<1%, n = 2). Only 3% (n = 134) were medically evaluated, and 29% (n = 1221) were sports-related. Head injuries were categorized as definite (3%, n = 137) and probable (13%, n = 572) concussions, with 39% (n = 277) being sports-related and 61% (n = 83) of definite concussions incurred by female campers. Summer camps, while an important location of head injury risk, appear to be a safe environment for youth.

Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 216-218
Author(s):  
Frank J. Genuardi ◽  
William D. King
Keyword(s):  
Head Injury ◽  
Injury Severity ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Medical Society ◽  
Discharge Instructions ◽  
Youth Athletes ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Grade 3

Objective. To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury. Methods. We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines. Results. We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion. Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.

The impact of blood ethanol concentration on the classification of head injury severity in traumatic brain injury

Brain Injury ◽  
2015 ◽  
Vol 29 (13-14) ◽  
pp. 1648-1653 ◽  
Author(s):  
Pål Rønning ◽  
Per Ole Gunstad ◽  
Nils-Oddvar Skaga ◽  
Iver Arne Langmoen ◽  
Knut Stavem ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Injury Severity ◽  
Ethanol Concentration ◽  
Blood Ethanol Concentration ◽  
The Impact ◽  
Head Injury Severity

scholarly journals Traumatic brain injury—the effects of patient age on treatment intensity and mortality

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ola Skaansar ◽  
Cathrine Tverdal ◽  
Pål Andre Rønning ◽  
Karoline Skogen ◽  
Tor Brommeland ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Injury Severity ◽  
Age Groups ◽  
Composite Score ◽  
Increased Risk ◽  
Management Intensity ◽  
Treatment Bias ◽  
Head Injury Severity

Abstract Background Ageing is associated with worse treatment outcome after traumatic brain injury (TBI). This association may lead to a self-fulfilling prophecy that affects treatment efficacy. The aim of the current study was to evaluate the role of treatment bias in patient outcomes by studying the intensity of diagnostic procedures, treatment, and overall 30-day mortality in different age groups of patients with TBI. Methods Included in this study was consecutively admitted patients with TBI, aged ≥ 15 years, with a cerebral CT showing intracranial signs of trauma, during the time-period between 2015–2018. Data were extracted from our prospective quality control registry for admitted TBI patients. As a measure of management intensity in different age groups, we made a composite score, where placement of intracranial pressure monitor, ventilator treatment, and evacuation of intracranial mass lesion each gave one point. Uni- and multivariate survival analyses were performed using logistic multinomial regression. Results A total of 1,571 patients with TBI fulfilled the inclusion criteria. The median age was 58 years (range 15–98), 70% were men, and 39% were ≥ 65 years. Head injury severity was mild in 706 patients (45%), moderate in 437 (28%), and severe in 428 (27%). Increasing age was associated with less management intensity, as measured using the composite score, irrespective of head injury severity. Multivariate analyses showed that the following parameters had a significant association with an increased risk of death within 30 days of trauma: increasing age, severe comorbidities, severe TBI, Rotterdam CT-score ≥ 3, and low management intensity. Conclusion The present study indicates that the management intensity of hospitalised patients with TBI decreased with advanced age and that low management intensity was associated with an increased risk of 30-day mortality. This suggests that the high mortality among elderly TBI patients may have an element of treatment bias and could in the future be limited with a more aggressive management regime.

scholarly journals Evidence of Prolonged Monitoring of Trauma Patients Admitted via Trauma Resuscitation Unit without Primary Proof of Severe Injuries

2020 ◽  
Vol 9 (8) ◽  
pp. 2516 ◽  
Author(s):  
Martin Heinrich ◽  
Matthias Lany ◽  
Lydia Anastasopoulou ◽  
Christoph Biehl ◽  
Gabor Szalay ◽  
...  
Keyword(s):  
Injury Severity ◽  
Treatment Completion ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Abbreviated Injury Scale ◽  
Severely Injured Patients ◽  
Severe Injuries ◽  
Level I ◽  
Evidence Based Guidelines ◽  
Injured Patients

Introductio: Although management of severely injured patients in the Trauma Resuscitation Unit (TRU) follows evidence-based guidelines, algorithms for treatment of the slightly injured are limited. Methods: All trauma patients in a period of eight months in a Level I trauma center were followed. Retrospective analysis was performed only in patients ≥18 years with primary TRU admission, Abbreviated Injury Scale (AIS) ≤ 1, Maximum Abbreviated Injury Scale (MAIS) ≤ 1 and Injury Severity Score (ISS) ≤3 after treatment completion and ≥24 h monitoring in the units. Cochran’s Q-test was used for the statistical evaluation of AIS and ISS changes in units. Results: One hundred and twelve patients were enrolled in the study. Twenty-one patients (18.75%) reported new complaints after treatment completion in the TRU. AIS rose from the Intermediate Care Unit (IMC) to Normal Care Unit (NCU) 6.2% and ISS 6.9%. MAIS did not increase >2, and no intervention was necessary for any patient. No correlation was found between computed tomography (CT) diagnostics in TRU and AIS change. Conclusions: The data suggest that AIS, MAIS and ISS did not increase significantly in patients without a severe injury during inpatient treatment, regardless of the type of CT diagnostics performed in the TRU, suggesting that monitoring of these patients may be unnecessary.

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