GUNSHOT WOUNDS TO THE BRAIN IN CHILDREN AND ADOLESCENTS - AGE AND NEUROBEHAVIORAL DEVELOPMENT

NEUROBEHAVIORAL OUTCOME AFTER craniocerebral gunshot wounds was evalua ted in a prospective, 3-year, longitudinal follow-up of a consecutive case series of 13 children and adolescents. The younger group was comp osed of seven children, ages 1.5 to 4 years, and the older group conta ined six children, ages 5 to 14. Outcome measures included the Glasgow Outcome Scale and neuropsychological assessment of intelligence, lang uage, motor, memory, attention, academic achievement, and adaptive beh avior. Glasgow Outcome Scale scores at baseline indicated moderate and severe disabilities in 69 and 23%, respectively. At the 3-year follow -up, 85% had moderate disabilities but only 8% were severely disabled. Significant and persistent neurobehavioral deficits varied with devel opmental level at the time of cerebral insult. Intellectual functionin g was clearly more impaired in children younger than 5 years of age at the time of injury than in older children. Cognitive and motor factor s were most closely related to deficits in the younger group. Disabili ty in older children and adolescents was associated with impaired atte ntion, adaptive behavior, and behavioral disturbance. Disabilities app ear to be at least as severe in our sample after cerebral gunshot woun ds as in our studies of severe pediatric closed-head injury. At the ti me of follow-up, younger children sustaining gunshot wounds had slight ly lower intelligence quotient scores and similar receptive language, expressive language, and gross motor scores compared with children wit h severe closed-head injury. The older gunshot wound patients were sig nificantly more impaired than patients with severe closed-head injurie s on measures of adaptive behavior and attention. Our findings suggest that early brain injury may not be associated with a more favorable p rognosis than comparable injuries in older children and that the type of deficits observed vary with developmental level at the time of inju ry.