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Outcome of closed head injury in Malaysian children: Neurocognitive and behavioural sequelae
Author(s) -
ONG LC,
CHANDRAN V,
ZASMANI S,
LYE MS
Publication year - 1998
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1046/j.1440-1754.1998.00239.x
Subject(s) - medicine , glasgow coma scale , cbcl , child behavior checklist , univariate analysis , head injury , neurocognitive , wechsler adult intelligence scale , pediatrics , physical therapy , clinical psychology , multivariate analysis , psychiatry , cognition
Objective: To compare the neurobehavioural outcome of children aged 6–12 years with severe closed head injury [sCHI] (coma >24 h), mild‐to‐moderate head injury [mCHI] (coma <6 h) and orthopaedic controls. Methods: Twenty‐nine children in each group, matched for age, sex and ethnicity, were assessed using the Glasgow Outcome Scale (GOS), Weschler Intelligence Scale for Children (WISC‐III), Movement Assessment Battery for Children (Movement ABC), Wide Range Assessment of Learning and Memory (WRAML) and a standardised neurological examination 6 months post‐injury. Parental reporting of pre‐ and post‐injury behaviour was documented using the Child Behaviour Checklist (CBCL). Results: Seven (24.1%) children with sCHI and three (10.3%) orthopaedic controls had residual motor deficits. Three (10.3%) children with sCHI and none in the other groups faced problems with independent ambulation. Twenty‐seven (93.1%) of those with sCHI and all children in the other groups had GOS scores of good recovery or moderate disability. Twenty‐two (81.5%) sCHI, five (18.5%) mCHI and one (3.7%) orthopaedic control reported a deterioration in school performance. manovas identified a significant injury group effect for performance skills ( P =0.007), verbal skills ( P =0.002), memory and learning ( P =0.001) and motor skills ( P =0.001). Repeated measures anova for pre‐ and post‐injury CBCL scores showed significant differences related to somatic complaints ( P =0.004), problems of socialising ( P =0.003), delinquency ( P =0.004), aggressiveness ( P =0.010), thought ( P <0.001) and attention ( P <0.001). Post‐hoc univariate analysis showed the significant differences were between that of the sCHI children and the other two groups. Conclusion: Although most sCHI children seemed to have made good physical recovery, there were cognitive, motor, memory and learning difficulties and behavioural problems concomitant with a deterioration in school performance compared with those with lesser or no head injury. This highlights the need for better integrated rehabilitation services to enable a gradual return into mainstream school.