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Traumatic Brain Injury in Children

14 April 2022

In his latest blog post, Ian Slater looks at a comprehensive research paper analysing neurocognitive outcomes following traumatic brain injury in children.

Not all research is created equal.

A case study is, as the name suggests, an in-depth, detailed examination of a particular case within a real-world context. In medicine, it may focus on an individual patient or ailment but, necessarily, is rather narrow in its presentation.

By contrast, Mark Goh and Shu-Ling Chong of Duke NUS Medical School and KK Women's and Children's Hospital, Singapore, undertook a systematic review and meta-analysis spanning 6,000 [!] articles, all reporting upon neurocognitive outcomes following traumatic brain injury (TBI)  in children.

The size of that feat is Herculean: I wouldn't even know where to start! 

Their research paper was published on 31 March 2021 in the Journal of Neurology, Neurosurgery and Psychiatry (JNNP) and can be downloaded here (pdf). For a slightly more accessible version of the research, the JNNP podcast can be accessed here via Apple podcasts but, in true BBC fashion, other podcast services are available too. You will hear the authors discuss how the dose of TBI impacts executive function and memory with potentially long term deficits.

For those of us dealing with child head injury claims, the conclusions are, superficially, not massively surprising, but it is important to recognise the distinction between deficits occurring in different areas of function.

For mild TBI, rather than the typically held belief that symptoms resolve within weeks or days, the findings reveal that deficits across the domains of complex attention, executive function and learning and memory can persist.

The same is true for those patients with moderate TBI, where deficits in executive function and learning and memory were found at 0 - 3 months and resolved, typically, by 12 - 18 months.

This is to be contrasted with children suffering from a severe TBI with domains spanning from executive function, language, learning and memory, to perceptual motor function all showing worse outcomes across all time [measured by the studies] points.

It should also be recognised that greater deficits were noted in patients aged 0 - 5 years compared with patients aged 5 - 18 years old. The younger the child, the more vulnerable the developing brain is to trauma. Contrary to the belief that neuroplasticity can help ameliorate the deficits, account needs to be taken of the way in which the young brain develops and matures.

TBI that occurs during periods of marked plasticity can severely blunt developmental trajectories of these young children resulting in long-term physical, cognitive, psychological and emotional impairments.

Due to its complexity and subject matter, this isn't the most accessible of research studies, but the podcast and indeed the JNNP series in general, is worth listening to if you have some free time when out walking the dog – they're only short!

Further Reading