TBI is the leading cause of disability in children and young adults and affects each child differently in terms of how they manage their daily life, including motor, neurocognitive, behaviour and school functioning.
Currently, treatment is hindered by the inability to understand and predict outcomes because of the wide differences in the nature and extent of TBI consequences, and a lack of good prognostic tools, which prevents clinicians from being able to tailor care to the individual or to properly inform the patient and their family about their expected outcome.
This can result in unnecessary and stressful follow-up investigations and certain impairments left undiagnosed.
Generally, the tools used to measure head injuries include the Glasgow Coma Scale score, symptoms present in the acute phase (loss of consciousness, amnesia) and CT-based information, which are combined to generate a diagnosis along the lines of mild, moderate and severe TBI.
But these tools are insufficient to predict the multi-factorial outcome differences that exist across the spectrum of TBI severity and, secondly, have almost exclusively been developed via adult patients, thereby failing to account for the developmental aspects of brain functioning vital for predicting the outcome in children.
The researchers plan to recruit 210 children aged between 4–18, diagnosed with mild-to-severe TBI from within research network of Dutch hospitals. Predictors in the model will include demographic, premorbid and clinical measures prospectively registered from the TBI hospital admission onwards as well as MRI metrics assessed at 1 month post-injury. Outcome measures of the prognostic models are motor functioning, intelligence, behavioural functioning and school performance, all assessed at 6 months post-injury.
Any improvements to TBI prognosis in children should result in families receiving more appropriate support, provide quicker and more effective monitoring and intervention, and effectively prevent poor outcome for individual children.
When the personal injury team takes on a brain injury case, the initial focus is to investigate what happened to the child to cause their brain injury, ascertain who is responsible for the injury and to get in place as quickly as possible the right medical care and rehabilitation.
Once liability has been admitted, often by the insurer of the at-fault driver, most families experience a long delay in settlement of their claim because the individual needs of each child are assessed over the next four or five years.
While care needs most of course be very carefully identified and costed, any model developed to speed up diagnosis and therefore needs will hugely benefit families often struggling to cope with their child's disability. More often than not, the parents take on the mantel of carers with little advice and support.
Specifically targeted treatment, rehabilitation and aids will always help a child to achieve their full potential and live a more fulfilled life.
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