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Abstract
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On Feb 21, the US Centers for Disease Control and Prevention (CDC), in collaboration with the National Institutes of Health, published the Report to Congress: The Management of Traumatic Brain Injury (TBI) in Children, to review the public health burden and to make recommendations for the future management and treatment of this population. In a field with such a lack of scientific research and evidence, the report has drawn on all existing resources and studies to comprehensively present the US experience.
TBI can be caused by a blow to the head and disrupts normal brain function. Symptoms of TBI include headaches, dizziness, memory difficulties, sleep disruption, and changes of mood. Contemporary TBI stratification is based on the Glasgow Coma Scale (GCS), with variations developed for children. As such, mild TBI (or concussion) is defined as an injury that results in a GCS score between 13 and 15; moderate TBI is defined as an injury that results in a GCS score between 8 and 12; and severe TBI is defined as an injury that results in a GCS score of 8 or lower.
Based on available data for the USA, the CDC estimates that mild TBI is experienced in 70–90% of TBI-related emergency department visits, moderate TBI by up to around 15%, and severe TBI by up to 2%. Severe TBI can have lasting effects that are life altering, leaving up to 61% of this group of children with a lifelong disability. Minority ethnic groups—including African American, Native American, and Hispanic children—were more likely to experience more severe TBI and had higher mortality rates than white children, with other factors such as family environment, age at injury, and access to health care influencing recovery from childhood TBI.
The CDC report assesses children in age groups of 0–14 years and 15–24 years, with types of injury showing broad trends across those groups. For the younger age group, the primary causes of TBI are falls and being struck by an object; and for the older group, the leading causes are motor accidents and falls, with both age groups also experiencing TBI through sports injuries (accounting for 430 000 US emergency department visits in 2012). For those aged 0–14 years, the numbers recorded in the USA in 2013 included 640 000 visits to emergency departments, 18 000 hospital stays, and 1500 deaths.
The effect of childhood TBI on families and wider society is not managed in an integrated or connected way. Similar to adult TBI, systems of care and categories do not work for individual cases, across age ranges, or between different types of TBI. That same disconnect exists in our understanding of the impact childhood TBI can have on wider social circumstances: schooling, friendships, family life, and future prospects. The interdependency with other aspects of life, including socioeconomic status, mental health and the developing brain, and the experience of individuals with coexisting conditions, such as attention deficit hyperactivity disorder, makes it very difficult to predict outcomes and very few studies have gathered sufficient data to inform practice...
Language: en |