16. Ewing-Cobbs L, Kramer L, Prasad M, Canales DN, Louis PT, Fletcher JM, Vollero H, Landry SH, & Cheung K. Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children
. Pediatrics. 1998;102:300-307.
Ewing-Cobbs et al. performed a prospective longitudinal study to analyze the neurobehavioral and developmental outcome findings in children with inflicted and noninflicted traumatic brain injury (TBI). They examined 40 children 0-6 years of age hospitalized for moderate and severe TBI and who had no documented previous history of brain injury and no neurological or metabolic disorder. There were 20 children in the inflicted TBI group and 20 children in the noninflicted group. The two groups were comparable in terms of ethnicity, socioeconomic background, gestational ages, neonatal complications and severity of injury. The two groups were not comparable in terms of age. The inflicted TBI group was younger at the time of injury (mean=10.6 months) compared to the noninflicted TBI group (mean=35.6 months).
Determination whether an injury was inflicted was based on the assessment of the hospital and county child protection services. An algorithm similar to the one presented by Duhaime et al (1992) was also used to make this determination. Skeletal surveys and funduscopic exams were performed on all children with suspected abusive injuries.
The outcomes of children suffering TBI were measured with multiple assessments including physical examination findings, the Glasgow Outcome Scale (adjusted for infants / children) and developmental measures. Developmental outcomes were measured with the Bayley Scales of Infant Development Mental and Motor Scales-Second Edition (for children 0-42 months at the time of assessment), the Stanford-Binet Intelligence Scale, Fourth Edition (for children aged 43-71 months at the time of assessment), and the McCarthy Scales of Children’s Abilities (for children aged 43-71 months).
Developmental measures were completed at an average of 1.3 months after TBI, following resolution of post-traumatic amnesia. Cognitive testing scores were different between the two groups. More children in the inflicted TBI group scored in the mentally deficient range compared to children in the noninflicted TBI group (45 percent vs. 5 percent). Motor testing scores were similar for both groups; 25 percent of the children in the noninflicted TBI group and 25 percent of the children in the inflicted TBI group scored in the mentally deficient range. In the inflicted TBI group, four patients had a good recovery, 13 patients had a moderate disability and three patients had a severe disability. Moderate disability is defined as hemiparesis, borderline cognitive scores, requiring more than one rehabilitation service or requiring early childhood intervention. Severe disability is defined as a total dependence for daily care, severe motor or cognitive deficiency.