Traumatic brain injury (TBI) in children represents a major public health burden in the United States and significant gaps in care need addressing, federal health officials said in a Report to Congress this week.
Congress directed the Centers for Disease Control and Prevention (CDC) to compile the report to review the burden of TBI in children, identify gaps in systems of care, and offer recommendations for improving short- and long-term outcomes in this vulnerable population.
“Over the past 30 years, we have seen a proliferation of research that better describes children’s brain development, outcomes from a TBI, and service needs. Unfortunately, services to support TBI management in children after initial injury care have declined in availability, length of time, and consistency within the United States,” the report notes.
In 2013, there were roughly 640,000 TBI-related emergency department (ED) visits, 18,000 TBI-related hospital admissions, and 1500 TBI-related deaths among children aged 14 years and younger. Leading causes of TBI in children include sports and recreational activities, motor vehicle crashes, and falls.
The effects of TBI can be chronic and disabling, the report notes. Longitudinal studies suggest that most children with mild TBI (mTBI) recover from the initial symptoms within 6 weeks of the injury; about 60% have persistent symptoms at 1 month after injury, 10% at 3 months, and less than 5% at 1 year.
TBI of any severity can have a negative effect on a child’s future ability to learn and perform in school, the report notes. Research has shown that children with moderate-to-severe TBI earn worse grades, show higher rates of being held back and receive more special education services than their uninjured peers. Other research has shown that 14% of children who experience mTBI need educational support services at school 12 months later.
While “very little” is known about the long-term adult outcomes of TBI in children, some evidence suggests childhood TBI may lead to lower educational and occupational attainment, the report notes.
Call to Action
The management of TBI in children is complex and depends on multiple service delivery systems that often do not provide systematic or coordinated care to ensure a successful recovery, the report notes.
“In particular, there is large variation in what constitutes follow-up care and service delivery in critical areas, such as insurance coverage, utilization of pediatric trauma centers, service delivery in the schools, early intervention services, support for transition to adulthood, and family support,” the report says.
Currently, there are no formal systems to monitor the health of children with a TBI over time. Another problem, the CDC says, is the lack of awareness of educators about the effects of TBI on learning.
The CDC is working to develop the first-ever evidence-based clinical guideline on the diagnosis and management of mTBI in children. The guideline will be based on recommendations from a federal advisory committee, informed by a pediatric mTBI guideline workgroup made up of leading experts in the field. The guideline is expected to be released this year.
Summing up, the CDC says the information provided in this report represents a “call-to-action” to improve the care children receive after a TBI so they can maximize their potential for recovery.
“Moving forward, this effort will require increased coordination and collaboration among the many stakeholders focused on the burden of TBI in children. All involved with the care of children can use this report and the opportunities for action within as a guide to improve care for children who sustain a TBI,” the CDC says.
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