This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
We very much appreciate the interest in our article shown by Vigil-Sewell and Sargent. We wish to comment on their arguments. First: What kind of patients could have been used as a control group? "Worse than expected" refers to the injured children themselves. Initial recovery and school performance give a more optimistic expectation of the late outcome than was shown when the outcome was assessed in adulthood. A selection bias is possible though improbable because in our health care system, all patients injured in motor vehicle–related accidents are referred to the Rehabilitationcentre's outpatient department (Kauniainen, Finland) for follow-up, even those children with expected full recovery, when the initial brain injury is considered severe. The final outcome was worse in children who were less than 4 years of age at the time of injury. This conclusion is based on the fact that none of those children were able to
Koskiniemi M, Kyykkä T, Nybo T, Jarho L. Long-term Outcome After Severe Brain Injury in Preschoolers Is Worse Than Expected-Reply. Arch Pediatr Adolesc Med. 1996;150(2):228. doi:10.1001/archpedi.1996.02170270110023