Long-term outcome after severe brain injury in preschoolers is worse than expected.

OBJECTIVE

To determine the long-term outcome after severe brain injury at preschool age.

DESIGN

Follow-up until adult life.

SETTING

A centralized guidance center for all traffic-associated injuries.

PATIENTS: Children with severe brain injury at preschool age between January 1959 and December 1969.

MAIN OUTCOME MEASURE: Final evaluation in adulthood was performed by our team. The capability to work and live independently was rated.

RESULTS

Twenty three (59%) of 39 children attended a typical school, eight (21%) attended a school for the physically disabled, and seven (18%) attended a school for the mentally retarded; information was not available for one child. In adulthood, nine patients (23%) were able to work full-time, 10 (26%) worked at sheltered workplaces, 14 (36%) lived independently at home, and six (15%) needed physical and/or psychotherapeutic support. The difference between normal school performance (59%) and capability to work full-time (23%) was significant (P < .05). In evaluating different aspects after the severe brain injury, the sense of identity was the best indicator of final outcome.

CONCLUSIONS

The final evaluation of severe brain injury at preschool age should be performed in adulthood. Normal school performance or normal intelligence functioning is not a guarantee for good long-term prognosis. To let the child develop a firm identity is essential for good outcome.