OBJECTIVE: The intellectual, behavioral, and social function of children who sustained traumatic brain injury (TBI) before 3 years of age were compared with a group of uninjured children. The role of injury and environmental factors in recovery was examined. METHODS: A group of 53 children who sustained a TBI before 3 years of age (20 mild and 33 moderate/severe) and 27 uninjured children (control group) were assessed on an IQ measure and parent measures of behavior and social skills. Children were aged 4 to 6 years and were an average of 40 months since sustaining their injury. RESULTS: There were no demographic differences between the groups. Although all group scores were in the average range, children with moderate/severe TBI performed significantly below uninjured children on an IQ measure. No significant differences were found on parent behavior ratings, although effect sizes between groups were medium to large. No differences were found for social skills. All outcomes were significantly influenced by environmental but not injury factors. CONCLUSIONS: Moderate/severe TBI at an early age appears to be associated with lowered intellectual function and possibly behavior problems. A child’s environment influences cognitive and behavior function after TBI. * Abbreviations: ANOVA — : analysis of variance CBCL — : Child Behavior Checklist FSIQ — : full-scale IQ GCS — : Glasgow Coma Scale K6 — : Kessler 6 Scale PIQ — : performance IQ SES — : socioeconomic status SSRS — : Social Skills Rating Scale TBI — : traumatic brain injury VIQ — : verbal IQ WPPSI-III — : Wechsler Preschool and Primary School Scale of Intelligence-III

Objective Typically, studies on outcomes after traumatic brain injury (TBI) have investigated whether a younger age at injury is associated with poorer recovery by comparing 2 age groups rather than participants injured across childhood. This study extended previous research by examining whether the influence of age on recovery fits an early vulnerability or critical developmental periods model. Methods Children with a TBI (n = 181) were categorized into 4 age-at-injury groups—infant, preschool, middle childhood, and late childhood—and were evaluated at least 2-years post-TBI on IQ. Results Overall, the middle childhood group had lower IQ scores across all domains. Infant and preschool groups performed below the late childhood group on nonverbal and processing speed domains. Conclusions Contrary to expectations, children injured in middle childhood demonstrated the poorest outcomes; this age potentially coincides with a critical period of brain and cognitive development.

Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting.

Objective The children's head injury algorithm for the prediction of important clinical events (CHALICE) is one of the strongest clinical prediction rules for the management of children with head injuries. The authors set out to determine the impact of this rule on the proportion of head injured patients receiving a CT scan in a major Australian paediatric emergency department. Design Retrospective cohort study. Setting Tertiary paediatric hospital emergency department in Australia (67 000 patients/year). Patients All head injured patients presenting to the emergency department in 2004. Main outcome measures Actual proportion of head injured patients receiving a CT scan compared with the proportion had the CHALICE algorithm been applied. Results There were 1091 head injuries of all severities during the study period. 18% of head injured patients had a Glasgow Coma Scale <15, 19% a CT scan and 1.4% neurosurgical intervention. Application of the CHALICE algorithm would result in 46% receiving a CT scan. 303 patients who fit CHALICE criteria did not have a CT scan. These patients were managed with admission for observation or discharge and head injury instructions. Only five of these (1.6% or 0.5% of total head injuries) received a CT scan on representation for ongoing symptoms, four of which showed abnormalities on CT scan. Conclusions Application of the CHALICE rule to this non-UK dataset would double the proportion of CT scans, with an apparent small gain in delayed pick-up of CT abnormalities. The role of expectant observation in hospital or at home needs to be defined.