title: Extended follow-up of neurological, cognitive, behavioral and academic outcomes after severe abusive head trauma.
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.
authors: Rehabilitation Department for Children with Acquired Neurological Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France; General Pediatric Department, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, F-75015 Paris, France; Paris Descartes University, 12 rue de l'Ecole de Médecine, F-75006 Paris, France.
authors: Katia
authors: K
authors: Lind
authors: Rehabilitation Department for Children with Acquired Neurological Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France; Outreach Team for Children and Adolescents with Acquired Brain Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France.
authors: Hanna
authors: H
authors: Toure
authors: Rehabilitation Department for Children with Acquired Neurological Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France; Outreach Team for Children and Adolescents with Acquired Brain Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France.
authors: Dominique
authors: D
authors: Brugel
authors: Paris Descartes University, 12 rue de l'Ecole de Médecine, F-75006 Paris, France; Pediatric Neurosurgery Department, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, F-75015 Paris, France.
authors: Philippe
authors: P
authors: Meyer
authors: Rehabilitation Department for Children with Acquired Neurological Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France; Outreach Team for Children and Adolescents with Acquired Brain Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France.
authors: Anne
authors: A
authors: Laurent-Vannier
authors: Rehabilitation Department for Children with Acquired Neurological Injury - Saint Maurice Hospitals, 14 rue du Val d'Osne, 94410 Saint Maurice, France; Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), 75013 Paris, France.
authors: Mathilde
authors: M
authors: Chevignard
mesh_terms: D001927:Brain Diseases / Q000209:etiology; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002653:Child Behavior Disorders / Q000209:etiology*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D006259:Craniocerebral Trauma / Q000523:psychology*; D004519:Education, Special / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D038642:Shaken Baby Syndrome / Q000523:psychology; D014786:Vision Disorders / Q000209:etiology
keywords: Abusive head trauma; Behavior; Cognitive impairment; Long-term outcome; School; Shaken baby syndrome