The Importance of early intervention and diagnosis of
PAEDIATRIC ACQUIRED BRAIN INJURY Do we need early intervention or diagnosis for brain injury rehabilitation? By Gerard Anderson, Head of Brain Injury Services at the Child Brain Injury Trust.
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ach year, thousands of children are admitted to AED with head injuries. NICE guidance advises that children presenting with a GCS of less than 15 should be assessed within 15 minutes of arrival to AED by a trained Gerard Anderson member of staff and receive a CT Head of Brain Head scan within one hour of a Injury Services risk factor of a brain injury being identified. Some of the children admitted to AED are diagnosed as having a concussion or postconcussive syndrome and discharged with some advice, others are admitted for overnight observation then discharged. Those who make it onto a trauma, surgical or general ward may be coded using the International Classification of Disease version 10 (ICD-10) with intracranial injury, skull fractures or crushing injuries of the head. With different imaging taking place, diagnosis given, and treatment prescribed, we are faced with a variation in coding and inconsistencies in accurate reporting of overall brain injuries caused by external force to the head.
NON-TRAUMATIC BRAIN INJURIES
Although traumatic brain injuries are a major cause of acquired brain injury, there are many other brain injuries that can at times be equally difficult to diagnose. Diagnosis of encephalitis, meningitis or other illness may cause cognitive impairment, but the long-term impact may be difficult to predict and can lead to a lack of reporting of secondary brain injury. This is true where brain injury is secondary to injuries caused by heart conditions, diabetes, or poisoning. If imagining is unremarkable, this can also be challenging, especially where conflicting presentation implies cognitive impairment. This can lead to 36
reintegration to normal routine sooner than may be advisable. Predicting recovery can also depend on the spread of injury as global injuries can be more difficult to recover from due to neurons being destroyed. This makes the brain injury harder to recover from, whereas traumatic or focal injuries tend to cause damage to the axons, allowing the brain to rewire itself and create new connections. Although this is based on those cases where imaging occurs, the reality is that most head injuries are mild and go undetected or are not accurately recorded, leaving the reported figures that are used, conservative.
IMPACT OF COMMUNITY INTEGRATED SERVICES
When a child is discharged from hospital, ‘Medically fit for discharge’ is the term often used and is what we define as the point at which there is no longer a need to continue the care of a patient in an acute setting, and where a patient can then continue their recovery in a non-acute environment. The true impact of these four words is often lost on a family. It is true that a large majority of children do make a good recovery and go back to their normal every-day activities, however for many others, medically fit for discharge is the beginning of their journey. From 1st April 2019 – 31st March 2020, the highest number of referrals made to the Child Brain Injury Trust for support were children involved in road traffic collisions (n-98). While medically fit for discharge, many families incorrectly assumed that the cognitive recovery would follow a similar trajectory as the physical recovery. For patients without a formal diagnosis or remarkable imagining, it makes it even more difficult. By working in partnership with clinical and nonclinical healthcare professionals, the Child Brain Injury Trust can support improved recovery post brain injury from the initial stages of injury, assisting in the transfer