ABSTRACT
The clinical presentation and final outcome of mild, moderate or severe injury in traumatic brain injury (TBI) primarily depends on the severity of and distribution of the brain damage and the child’s age (Johnson and Rose 1996). Minor injuries account for more than 75 per cent of TBI (Durkin et al. 1998) with the outcome generally very good (Satz et al. 1997). The survival rate following severe TBI has increased as a result of technological advances such as computerized tomography (CT) scanning (Hirsch et al. 2002), changes in medical management including an increased use of intracranial pressure and cerebral function monitoring (Tilford et al. 2001), and a more systematic approach to the initial assessment and early management following TBI (National Institute for Health and Clinical Excellence (NICE) 2003, 2007). However, severe TBI has the potential to cause significant morbidity including physical, cognitive and emotional disabilities (Mahoney et al. 1983). The focus of this chapter is primarily severe TBI and will provide an overview of the factors which predispose children to TBI, outline the types of injury and the management of children following TBI. It may be useful to revisit Chapter 2, Section 3 – normal and raised intracranial pressure – because of the links with the acute management of TBI, and Chapter 2, Section 8 – the principles of rehabilitation.
