Moderate-to-Severe Traumatic Brain Injury in Children

Complications and Rehabilitation Strategies

Myra L. Popernack, MSN, RN, CPNP; Nicola Gray, BSN, RN; Karin Reuter-Rice, PhD, CPNP-AC, FCCM, FAAN

Disclosures

J Pediatr Health Care. 2015;29(3):e1-e7. 

In This Article

Abstract and Introduction

Abstract

Traumatic brain injury (TBI) is the leading cause of death in children in the United States. Each year 37,200 children sustain a severe TBI, with up to 1.3 million life-years potentially adversely affected. Severe pediatric TBI is associated with significant mortality and morbidity. Of the children who survive their injury, more than 50% experience unfavorable outcomes 6 months after the injury. Although TBI-associated death rates decreased between 1997–2007, disabilities for TBI survivors continue to have both a direct and indirect impact on the economic and human integrity of our society. The degree of disability varies with the severity and mechanism of the injury, but a realm of physical and emotional deficits may be evident for years after the injury occurs. This article describes the pathophysiology of moderate to severe TBI, its associated complications, and opportunities to improve patient outcomes through use of acute management and rehabilitation strategies. To address the many challenges for TBI survivors and their families, including significant financial and emotional burdens, a collaborative effort is necessary to help affected children transition seamlessly from acute care through long-term rehabilitation.

Introduction

Traumatic brain injury (TBI) is the leading cause of death in children in the United States. In 2010, 2.5 million Americans sustained a TBI ranging from mild to severe (Centers for Disease Control and Prevention [CDC], 2014). Each year 37,200 children sustain a severe TBI, with up to 1.3 million life-years potentially adversely affected. According to the CDC, 7440 children died of TBI in 2005, and the full extent of the injury is likely underestimated (CDC, 2014). Based on the current best estimates, severe pediatric TBI has a 20% mortality, with a 50.6% unfavorable 6- month outcome. Although TBI-associated death rates have decreased between 1997–2007, disabilities for TBI survivors continue to have both a direct and indirect impact on the economic and human integrity of our society (Aitken et al., 2009, Coronado et al., 2011). The degree of disability varies with the severity and mechanism of the injury, but physical, cognitive, emotional, and behavioral deficits may be evident for years after the injury. This article describes the pathophysiology of moderate to severe TBI, its associated complications, and opportunities to improve patient outcomes using acute management and rehabilitation strategies. To address the many challenges for TBI survivors and their families, including significant financial and emotional burdens, a collaborative effort is necessary to help affected children and their families transition seamlessly from acute care through long-term rehabilitation.

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