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The families of 97 children with mild (49), moderate (19) and severe (29) traumatic brain injury (TBI), aged 5-15 at injury, were interviewed and assessed at a mean of 2.29 years postinjury and compared with 31 healthy controls. Following the TBI, 83 (85.6%) had no therapeutic input, 74 families (76.3%) had unmet information needs, particularly regarding long-term consequences. At first interview 1097 problems were reported by the TBI group. Behavioural and school problems were frequently reported by all TBI groups, significantly more than controls (p  0.001). On the Vineland Adaptive Behaviour Scales 63% of mild and 70% of severe TBI groups demonstrated significant maladaptive behaviour. Children in the mild and moderate/severe groups were significantly more anxious than controls on the HADS (p  0.05). At 12 month follow-up there were no significant differences in problem resolution between the TBI groups, 498 (53.9%) problems remained unchanged and 75 (8.1%) had worsened.3

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Aims: To examine return to school and classroom performance following traumatic brain injury (TBI). Methods: This cross-sectional study set in the community comprised a group of 67 school-age children with TBI (35 mild, 13 moderate, 19 severe) and 14 uninjured matched controls. Parents and children were interviewed and children assessed at a mean of 2 years post injury. Teachers reported on academic performance and educational needs. The main measures used were classroom performance, the Children's Memory Scale (CMS), the Wechsler Intelligence Scale for Children-third edition UK (WISC-III) and the Weschler Objective Reading Dimensions (WORD). Results: One third of teachers were unaware of the TBI. On return to school, special arrangements were made for 18 children (27%). Special educational needs were identified for 16 (24%), but only six children (9%) received specialist help. Two thirds of children with TBI had difficulties with school work, half had attention/concentration problems and 26 (39%) had memory problems. Compared to other pupils in the class, one third of children with TBI were performing below average. On the CMS, one third of the severe group were impaired/borderline for immediate and delayed recall of verbal material, and over one quarter were impaired/borderline for general memory. Children in the severe group had a mean full-scale IQ significantly lower than controls. Half the TBI group had a reading age >1 year below their chronological age, one third were reading >2 years below their chronological age. Conclusions: Schools rely on parents to inform them about a TBI, and rarely receive information on possible long-term sequelae. At hospital discharge, health professionals should provide schools with information about TBI and possible long-term impairments, so that children returning to school receive appropriate support.

Article Title: Prevalence of traumatic brain injury amongst children admitted to hospital in one health district: a population-based study AbstractThere is a dearth of information regarding the prevalence of brain injury, serious enough to require hospital admission, amongst children in the United Kingdom. In North Staffordshire a register of all children admitted with traumatic brain injury (TBI) has been maintained since 1992 presenting an opportunity to investigate the incidence of TBI within the region in terms of age, cause of injury, injury severity and social deprivation. The register contains details of 1553 children with TBI, two thirds of whom are male.This population-based study shows that TBI is most prevalent amongst children from families living in more deprived areas, however, social deprivation was not related to the cause of injury. Each year, 280 per 100,000 children are admitted for ≥24 hours with a TBI, of these 232 will have a mild brain injury, 25 moderate, 17 severe, and 2 will die. The incidence of moderate and severe injuries is higher than previous estimates. Children under 2 years old account for 18.5% of all TBIs, usually due to falls, being dropped or non-accidental injuries. Falls account for 60% of TBIs in the under 5s. In the 10-15 age group road traffic accidents were the most common cause (185, 36.7%). These findings will help to plan health services and target accident prevention initiatives more accurately.

Main Outcomes and Results: Two-thirds of children with a TBI exhibited significant behavioural problems, significantly more than controls (p=0.02). Children with behavioural problems had a mean IQ approximately 15 points lower than those without (p=0.001, 95% CI:7 to 26.7). At school, 76%(19) of children with behavioural problems also had difficulties with schoolwork. Behavioural problems were associated with social deprivation and parental marital status (p ≤ 0.01). Conclusions:Children with TBI are at risk of developing behavioural problems which may affect school performance. Children with TBI should be screened to identify significant behavioural problems before they return to school. 2

Objectives: To identify outcomes following head injury (HI) among a population of children admitted to one hospital centre and to compare outcomes between different severity groups. Methods: A postal follow up of children admitted with HI to one National Health Service Trust, between 1992 and 1998, was carried out. Children were aged 5-15 years at injury (mean 9.8), followed up at a mean of 2.2 years post-injury. Parents of 526 injured children (419 mild, 58 moderate, 49 severe) and 45 controls completed questionnaires. Outcomes were assessed using the King's Outcome Scale for Childhood Head Injury (KOSCHI). Results: Frequent behavioural, emotional, memory, and attention problems were reported by one third of the severe group, one quarter of the moderate, and 10-18% of the mild. Personality change since HI was reported for 148 children (28%; 21% mild HI, 46% moderate, 69% severe). There was a significant relationship between injury severity and KOSCHI outcomes. Following the HI, 252 (48%) had moderate disability (43% mild HI, 64% moderate, 69% severe), while 270 (51%) made a good recovery (57% mild HI, 36% moderate, 22% severe). There was a significant association between social deprivation and poor outcome (p = 0.002). Only 30% (158) of children received hospital follow up after the HI. All children with severe disability received appropriate follow up, but 64% of children with moderate disability received none. No evidence was found to suggest a threshold of injury severity below which the risk of late sequelae could be safely discounted. Conclusions: Children admitted with mild HI may be at risk of poor outcomes, but often do not receive routine hospital follow up. A postal questionnaire combined with the KOSCHI to assess outcomes after HI may be used to identify children who would benefit from clinical assessment. Further research is needed to identify factors that place children with mild HI at risk of late morbidity.

Objectives-To determine whether patients who return to driving after head injury can be considered safe to do so and to compare the patient characteristics of those who return to driving with those who do not. Methods-In a multicentre qualitative study 10 rehabilitation units collectively registered 563 adults with traumatic brain injury during a 2.5 year period. Recruitment to the study varied from immediately after hospital admission to several years after injury. Patients and their families were interviewed around 3 to 6 months after recruitment. A total of 383 (67.5%) subjects were interviewed within 1 year of injury, of whom 270 (47.6%) were interviewed within 6 months of injury. Main outcome measures were the presence or absence of driving related problems reported by drivers and ex-drivers, and scores on driving related items of the functional independence/functional assessment measure (FIM+FAM). Results-Of the 563 patients 381 were drivers before the injury and 139 had returned to driving at interview. Many current drivers reported problems with behaviour (anger, aggression, irritability; 67 (48.2%)), memory ( 89 (64%)), concentration and attention (39 (28.1%)), and vision (39 (28.1%)). Drivers reported most driving related problems as often as ex-drivers, main exceptions were epilepsy and community mobility. Current drivers scored significantly higher on the FIM+FAM (were more independent), than ex-drivers. The driving group had sustained less severe head injuries than ex-drivers; nevertheless, 78 (56.2%) current drivers had received a severe head injury. Few (61 (16%)) previous drivers reported receiving formal advice about driving after injury. Conclusions-The existence of problems which could significantly aVect driving does not prevent patients returning to driving after traumatic brain injury. Patients should be assessed for both mental and physical status before returning to driving after a head injury, and systems put in place to enable clear and consistent advice to be given to patients about driving. (J Neurol Neurosurg Psychiatry 2001;70:761-766)