Neurological and mental outcome after severe head injury in childhood: a long-term follow-up of 318 children.

PURPOSE: Identification of prognostic risk factors in paediatric head injury.

METHOD: Long-term follow-up of 318 children with severe head injuries with a mean follow-up period of 8 years and 9 months. The neurological and mental outcome was classified by the Glasgow Outcome Scale and the Frankfurt Mental Outcome Scale.

RESULTS

Prognostic risk factors were a primary post-traumatic vigilance disturbance longer than 24 hours, less than seven points on the Glasgow Coma Scale, an increased intracranial pressure with cerebral perfusion pressure below 50 mmHg, age at accident younger than 2 years, physical abuse and the development of post-traumatic epilepsy.

CONCLUSIONS

The infant brain is more vulnerable to lasting deficits and is more prone to post-traumatic seizure development. Post-traumatic epilepsy itself causes a deterioration in outcome because of the developmental disturbance at epilepsy onset and often unfavourable course. Physically abused children with their often multiple and repeated head injuries are predestined for poor outcome.