Survival with brain injury is an outcome of severe illness that may be becoming more common. Provision for children in this situation has received little attention | Archives of Disease in Childhood
Objectives: We sought to estimate rates of severe paediatric acquired brain injury (ABI) requiring rehabilitation and to describe current provision of services for these children in the UK.
Methods: This study conducted an analysis of Hospital Episode Statistics data between April 2003 and March 2012, supplemented by a UK provider survey completed in 2015. A probable severe ABI requiring rehabilitation (PSABIR) event was inferred from the co-occurrence of a medical condition likely to cause ABI (such as meningitis) and a prolonged inpatient stay (>=28 days).
Results: During the period studied, 4508 children aged 1–18 years in England had PSABIRs. Trauma was the most common cause (30%) followed by brain tumours (19%) and anoxia (18.3%). An excess in older males was attributable to trauma. We estimate the incidence of PSABIR to be at least 2.93 (95%CI 2.62 to 3.26) per 100 000 young people (1–18 years) pa. The provider survey confirmed marked geographic variability in the organisation of services in the UK.
Conclusions: There are at least 350 PSABIR events in children in the UK annually, a health problem of similar magnitude to that of cerebral palsy. Service provision for this population varies widely around the UK, in contrast with the nationally coordinated approach to paediatric intensive care and major trauma provision.
Full reference: Hayes, L. et al. (2017) Requirements for and current provision of rehabilitation services for children after severe acquired brain injury in the UK: a population-based study. Archives of Disease in Childhood. Vol. 102 (no. 09) pp. 813-820.
Researchers have developed and refined a blood test that could help clinicians identify infants who may have had bleeding of the brain as a result of abusive head trauma, sometimes referred to as shaken baby syndrome | ScienceDaily
The serum-based test, which needs to be validated in a larger population and receive regulatory approval before being used in clinical practice, would be the first of its kind to be used to detect acute intracranial hemorrhage, or bleeding of the brain. Infants who test positive would then have further evaluation via brain imaging to determine the source of the bleeding.
However, approximately 30 percent of AHT diagnoses are missed when caretakers provide inaccurate histories or when infants have nonspecific symptoms such as vomiting or fussiness. Missed diagnoses can be catastrophic as AHT can lead to permanent brain damage and even death.
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Narang, S.K. et al. The Journal of Pediatrics. Published online: 22 July 2016
Objective: To assess the current general acceptance within the medical community of shaken baby syndrome (SBS), abusive head trauma (AHT), and several alternative explanations for findings commonly seen in abused children.
Study design: This was a survey of physicians frequently involved in the evaluation of injured children at 10 leading children’s hospitals. Physicians were asked to estimate the likelihood that subdural hematoma, severe retinal hemorrhages, and coma or death would result from several proposed mechanisms.
Results: Of the 1378 physicians surveyed, 682 (49.5%) responded, and 628 were included in the final sample. A large majority of respondents felt that shaking with or without impact would be likely or highly likely to result in subdural hematoma, severe retinal hemorrhages, and coma or death, and that none of the alternative theories except motor vehicle collision would result in these 3 findings. SBS and AHT were comsidered valid diagnoses by 88% and 93% of the respondents, respectively.
Conclusions: Our empirical data confirm that SBS and AHT are still generally accepted by physicians who frequently encounter suspected child abuse cases, and are considered likely sources of subdural hematoma, severe retinal hemorrhages, and coma or death in young children. Other than a high-velocity motor vehicle collision, no alternative theories of causation for these findings are generally accepted.
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