The functional outcome in 95 children (aged 5 to 15) at 1 year after hospitalization for head injury was evaluated at the Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD. More than half of all injuries were motor vehicle related: 21% pedestrians, 18% passengers, and 17% bicycles. Lower extremity injuries were sustained in 20. Severity of head injury was determined using the Abbreviated Injury Scale (AIS 2-5) and the Glasgow Coma Scale (GCS 3-15). GCS were highly correlated with AIS severity. Chronic health problems pre-dating the injury were reported in 23%; these were minor in 15%, and major (mental retardation, seizures, lead poisoning) in 8%. After controlling for head injury severity, poorer outcomes were associated with poverty, preinjury chronic health problems, and lower extremity injuries. At 1 year follow-up, 55% had one or more health problems: headaches in 32%, limb or peripheral nerve disorders (13%), weakness or ataxia (7%), and vision, hearing, or speech disorder (6%). The presence of functional limitations in physical activity (31%) or self-care mobility (19%) was associated especially with severe head injuries (AIS 5), but those with AIS 2-4 were not spared at least one limitation. Hyperactive behavior was directly correlated with head injury severity, and head-injured children had a greater number of behavioral problems at 1 year follow-up when compared with a randomly selected sample of children, ages 6 to 16 years. [1]

COMMENT. In children who sustain head injury, the severity of the injury is correlated with preinjury health status, and even those with minor injuries have a greater incidence of chronic health problems than the general population. The risk of post-injury functional limitations was increased in children with a history of chronic ill-health and those who sustained lower extremity injuries. Evidence of cognitive, physical, or behavioral dysfunction requires intervention and rehabilitation.

The frequency of postconcussive symptoms in 41 children (ages 6-12) with traumatic brain injury (TBI) was evaluated at the Dept of Psychology, Case Western Reserve University, Cleveland, OH. Compared to 40 controls with orthopedic injuries only, those with TBI had more postconcussive symptoms both at baseline and at 6 month follow-up. The number of symptoms was related to injury severity and initial loss of consciousness (GCS <9), Nonverbal IQ, and the baseline Children’s Depression Inventory. [2]