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Childhood traumatic brain injury linked to long-term health issues

There are potentially causal effects between childhood and adolescent traumatic brain injury and later, long-term impairments with regard to a range of health and social outcomes, according to data published in PLOS Medicine.

The researchers further concluded that age-sensitive clinical guidelines and preventive strategies should be targeted at children and adolescents.

“The WHO ranks traumatic brain injury as the leading cause of both disability and mortality in individuals below the age of 45 [years],” Amir Sariaslan, PhD, MSc, BSc, of the department of psychiatry at the University of Oxford, Warneford Hospital, in the United Kingdom, and colleagues wrote. “… Epidemiological studies have consistently found higher rates of adverse outcomes in adults who have sustained a [traumatic brain injury] when compared to the general population. However, there is a lack of large-scale studies that have examined the potential long-term impact of [traumatic brain injury] exposure during childhood and adolescence.”

To study the association between traumatic brain injury during childhood and adult mortality, psychiatric morbidity and social outcomes, the researchers analyzed a Swedish birth cohort of 1,143,470 individuals between 1973 and 1985. Of that group, the researchers identified the 104,290 who had sustained at least one traumatic brain injury up to age 25 years and their unaffected siblings (n = 68,268). These individuals were assessed for various outcomes, including disability pension, specialist diagnosis of psychiatric disorders and psychiatric inpatient hospitalization, mortality prior to age 41 years, failing to achieve secondary school qualifications and receiving means-testing welfare benefits.

In addition to relative risk estimates, the researchers determined absolute risks by calculating prevalence and Kaplan-Meier estimates. In a complementary analysis, they also tested whether the findings were moderated by injury severity, recurrence and age at first injury.

According to the researchers, traumatic brain injury was associated with elevated risks for impaired functioning in adulthood across all outcome measures. Following a median follow-up period of 8 years from age 26 years, traumatic brain injury was associated with absolute risks of more than 10% for specialist diagnoses of psychiatric disorders and low education. In addition, it was associated with absolute risks of approximately 5% for disability pension, and 2% for early death. The highest relative risks, adjusted for sex, birth year and birth order, were found for psychiatric inpatient hospitalization (aRR = 2; 95% CI, 1.9-2; 6,632 vs. 37,095 events), disability pension (aRR = 1.8; 95% CI, 1.7-1.8; 4,691 vs. 29,778 events) and early death (aRR = 1.7; 95% CI, 1.6-1.9; 799 vs. 4,695 events).

Injury recurrence was associated with a 3-fold risk increase for disability pension (aRR = 2.6; 95% CI, 2.4-2.8) compared with single instances of traumatic brain injury. High risks for all outcomes were noted for individuals who suffered their first injury at an older age, from 20 to 24 years, with a more than 25% increase in relative risk compared to those aged 0 to 4 years.

“Currently most children with significant head injuries receive no systematic long-term follow-up,” Sariaslan and colleagues wrote. “An implication of our findings is that this should change. Services should consider how to routinely and systematically review these children on a regular basis to allow the subtle but important neurological, cognitive and psychiatric consequences of [traumatic brain injury] to be identified.” – by Jason Laday

Disclosure: Sariaslan reports no relevant financial disclosures. See the full study for additional author disclosures.