Extended follow-up of neurological,cognitive, behavioral and academic outcomes after severe abusive head trauma |
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| Institution: | 1. Rehabilitation Department for Children with Acquired Neurological Injury – Saint Maurice Hospitals, 14 rue du Val d’Osne, 94410 Saint Maurice, France;2. General Pediatric Department, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, F-75015 Paris, France;3. Paris Descartes University, 12 rue de l’Ecole de Médecine, F-75006 Paris, France;4. Outreach Team for Children and Adolescents with Acquired Brain Injury – Saint Maurice Hospitals, 14 rue du Val d’Osne, 94410 Saint Maurice, France;5. Pediatric Neurosurgery Department, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, F-75015 Paris, France;6. Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale (LIB), 75013 Paris, France;1. Service de radiologie pédiatrique, CHU de Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France;2. Service d’ophtalmologie pédiatrique, CHU de Pitié-Salpétrière, AP–HP, 47-83, boulevard de l’Hôpital, 75013 Paris, France;3. CESP centre de recherche en épidémiologie et santé des populations, Inserm, U1018, 94807 Villejuif, France;4. Service de santé publique, CHU de Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France;5. Unité médico-judiciaire, AP–HP, Hôtel Dieu, 1, place du Parvis-Notre-Dame, 75004 Paris, France;6. Faculté de médecine, université Paris Sud, 94270 Le Kremlin-Bicêtre, France;1. Department of Pediatrics, University of British Columbia, 4480 Oak Street, F507, Vancouver, British Columbia, V6H3V4, Canada;2. Faculty of Health Sciences, Simon Fraser University, Children''s Health Policy Centre, 2439–515 West Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada;3. Department of Psychiatry, University of British Columbia, Room 002, Pearkes Building, Queen Alexandra Centre for Children’s Health, 2400 Arbutus Road, Victoria, British Columbia, V8N 1V7, Canada;4. School of Interactive Art & Technology, Simon Fraser University, #250 13450 102nd Avenue (Podium 2–2832), Surrey, British Columbia, Canada;5. Department of Statistics, University of British Columbia, 4480 Oak Street, F508, Vancouver, British Columbia, V6H3V4, Canada;1. Department of Pediatrics, Penn State College of Medicine, Penn State Health Children’s Hospital, Hershey, PA, United States;2. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States;3. Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, the Netherlands;4. Department of Pediatrics, Children’s Hospital of Richmond, Richmond, VA, United States;5. Departments of Neurosurgery and Pediatrics, Penn State College of Medicine, Hershey, PA, United States;6. Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Medical Center, Salt Lake City, UT, United States;7. Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, United States;8. Department of Pediatrics, University of Nebraska Medical Center, Children’s Hospital and Medical Center, Omaha, NE, United States;9. Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, United States;1. Department of Ophthalmology & Visual Sciences, Montefiore Medical Center, Bronx, New York;2. Albert Einstein College of Medicine, Bronx, New York;3. Department of Surgery (Trauma), Jacobi Medical Center, Bronx, New York;4. Research Services, University of Pennsylvania, Philadelphia, Pennsylvania;5. Department of Surgery (Ophthalmology), Jacobi Medical Center, Bronx, New York;1. Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA;2. The Ohio State University College of Medicine, 370 W. 9th Ave., Columbus, OH 43210, USA;3. The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA;4. Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Building 421, Philadelphia, PA 19104, USA;5. Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA;6. University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA;7. Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA;8. University of Washington School of Medicine, 4333 Brooklyn Ave. NE, Seattle, WA 98105, USA;9. Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Ave., Pittsburgh, PA 15224, USA;10. Safar Center for Resuscitation Research, 3434 Fifth Ave., University of Pittsburgh 15260, USA |
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| Abstract: | Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD = 3.2). After a median length of follow-up of 8 years (range 3.7–12), only seven children (15%) had “good outcome” (normal life – GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p = 0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes. |
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| Keywords: | Abusive head trauma Shaken baby syndrome Long-term outcome Cognitive impairment Behavior School |
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