Quality of life in children after mild head injury

Abstract

Introduction: The study was conducted to evaluate the effects of Mild Head Injury (MHI) in children not only in terms of impairment, but also in terms of disability, handicap and quality of life (QOL).

Context: Emergency Clinical Hospital "Bagdasar-Arseni", Bucharest, Romania, between 2000 and 2004

Methods: We take into account the patients with mild head injury MHI (CCS of 14 and 15 and amnesia). From a cohort of 1,319 children, consecutive patients with MHI, presented at the emergency room in a period of four years (2000-2003), 528 children (40.0%) were selected for admission, based on the presence of the risk factors. All admitted patients were investigated based on a protocol of neurosurgical evaluation and were followed for a period of 12 months.

Results: The Falls were the most common cause of MHI (30.6% - 162 cases). The proportion of children with detectable CT scan abnormalities was smaller (19.8% - 105 cases) and surgery was necessary in only 5.5% (29 cases). Special attention was paid to child-abuse and traffic accident cases. Post-concussion syndrome (PCS) was observed in 26.9% cases. Neuropsychological tests were performed in 96 children (21.2%), to evaluate neuropsychological, emotional, psychosocial and behavioral impairments. The study has shown that cognitive dysfunctions mainly were observed after MHI (especially deficits in information processing speed, memory and attention).

Conclusions: The neurosurgeon should perform a complete evaluation of the children-patient with MHI, including a current physical examination, a neuro-radiological evaluation and a formal neuropsychological assessment, in order to detect the abnormalities and to treat them. Psychotherapy can be of benefit in cases with MHI. Any common case of MHI may hide a possible lesion with delayed consequences.

Chart 1

The age distribution in children

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Focused attention. “Digit span" subtest of WISC

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Divided Attention. "Digit symbol" subtest of WISC

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Divided attention correlate with age of children

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Children’s Volume of attention. "Rey Auditory Test" first trial

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The volume of attention correlates with children gender. "Auditory Verbal Learning Test"

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Initial fatigability in children

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Fatigability in children after 12 months

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The volume of memory. “Auditory Verbal Learning Test" - 5th trial

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Integrative thinking

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Premorbid characteristics in children

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Initial mood

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Children' predisposition

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Children' predisposition

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Depression

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Symptoms and children’s performance

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Consciousness level and children’s performance

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Psychotherapeutically effects in children

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Psychotherapeutically effects in children