Neurological and mental outcome after severe head injury in childhood: a long-term follow-up of 318 children

Purpose: Identification of prognostic risk factors in paediatric head injur y. Method: Long-term follow-up of 318 children with severe head injuries with a mean follow-up period of 8 years and 9 months. The neurological and menta l outcome was classified by the Glasgow Outcome Scale and the Frankfurt Men tal Outcome Scale. Results: Prognostic risk factors were a primary post-traumatic vigilance di sturbance longer than 24 hours, less than seven points on the Glasgow Coma Scale, an increased intracranial pressure with cerebral perfusion pressure below 50 mmHg, age at accident younger than 2 years, physical abuse and the development of post-traumatic epilepsy. Conclusions: The infant brain is more vulnerable to lasting deficits and is more prone to post-traumatic seizure development. Post-traumatic epilepsy itself causes a deterioration in outcome because of the developmental distu rbance at epilepsy onset and often unfavourable course. Physically abused c hildren with their often multiple and repeated head injuries are predestine d for poor outcome.