March 1995

Long-term Outcome After Severe Brain Injury in Preschoolers Is Worse Than Expected

Author Affiliations

From the Kauniala Hospital for Disabled War Veterans and the Rehabilitationcentre of Insurance Companies, Kauniainen, Finland (Drs Koskiniemi and Jarho and Messrs Kyykkä and Nybo), and the Department of Virology, University of Helsinki (Dr Koskiniemi), Finland.

Arch Pediatr Adolesc Med. 1995;149(3):249-254. doi:10.1001/archpedi.1995.02170150029004

Objective:  To determine the long-term outcome after severe brain injury at preschool age.

Design:  Follow-up until adult life.

Setting:  A centralized guidance center for all trafficassociated injuries.

Patients:  Children with severe brain injury at preschool age between January 1959 and December 1969.

Main Outcome Measure:  Final evaluation in adulthood was performed by our team. The capability to work and live independently was rated.

Results:  Twenty three (59%) of 39 children attended a typical school, eight (21%) attended a school for the physically disabled, and seven (18%) attended a school for the mentally retarded; information was not available for one child. In adulthood, nine patients (23%) were able to work full-time, 10 (26%) worked at sheltered workplaces, 14 (36%) lived independently at home, and six (15%) needed physical and/or psychotherapeutic support. The difference between normal school performance (59%) and capability to work full-time (23%) was significant (P<.05). In evaluating different aspects after the severe brain injury, the sense of identity was the best indicator of final outcome.

Conclusions:  The final evaluation of severe brain injury at preschool age should be performed in adulthood. Normal school performance or normal intelligence functioning is not a guarantee for good long-term prognosis. To let the child develop a firm identity is essential for good outcome.(Arch Pediatr Adolesc Med. 1995;149:249-254)