Monthly Archives: December 2011

Pediatric Neuro Trauma


Most people tend to assume that children are near-Herculean in regards to injury. As an EMT I see this all the time. Kids are bouncy. Something that would knock me flat on my back they respond to with no more than giggles. As with any oversimplification, there are catches especially with the brain.

Here we have a paper that takes a look at the overall effect of traumatic cranial injuries in small children and the resulting trend in performance scores. The researchers lurked around an emergency room of a children’s hospital waiting for cases of cranial trauma. They included everything from kids taking a minor spill to those involved in car accidents to those pretending they were Superman. Upon admission they were categorized via age (infant 0-2, young 3-7, and old 8-12) and Glasgow coma score (scale of 3-15: If you’re reading this, you’re a 15) as a ranking of severity.

From there they tested the kids multiple cognitive scales to determine where they ranked verbally, globally, etc. They did this 24 hours post-injury, 12 months after, and at 30 months.

 

This graph is of particular interest to me as it shows every category simultaneously. The key lines to focus on are the old severe and infant moderate/severe. What we can see from this data is that age and severity both play an enormous role in the final outcome of the patient. The younger that the patient is at the time of insult the greater the long term detriment. Additionally, the severity of the insult is an important indicator of long term recovery (as one would expect).

This model does not hold true in all instances though. When examining people who require hemispherectomies to control severe seizure activity, we see a completely different result. Older is worse; younger is better. While in the above trauma example, the lack of developed pathways hampers recovery. Yet in removing an entire hemisphere of the brain this is actually beneficial. These pathways haven’t been strengthened and are thus more malleable to change. Huzzah plasticity!

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