Mild Traumatic Brain Injury in Children and Adolescents
Significant numbers of individuals sustain a mild traumatic brain injury (TBI) at some point during their childhood or adolescence. Approximately 30% of the students in one survey (Segalowitz & Brown, 1991) of more than 600 high school students reported having experienced a history of head injury, with half of these adolescents reporting an associated period of loss of consciousness. The diagnosis of concussion, which may include
brief or transient disruption of neurologic function, headache, nausea, or vomiting, has also been reported with considerable frequency in another survey of adolescents and young adults (Roberts et al., 1990) and has been associated with persistent neurobehavioral dysfunction even years after the mild injury occurred (Klonoff, Clark, & Klonoff, 1995; Lundar & Nesvold, 1985; Roberts, Verduyn, Manshadi, & Hines, 1996; Wrightson, McGinn, & Gronwald, 1995). In one report of hospital admissions, approximately 90% of those pediatric patients admitted to a hospital for evaluation and treatment of TBI were considered mild or minor (Kraus, Fife, Cox, Ramstein, & Conroy, 1986). However, incidence figures based on hospital admissions alone, are lower than the actual rate of occurrence as they do not include those pediatric patients who are treated in the emergency room and released or examined by their local physician. The numbers begin to reach epidemic proportions as surveys (Alves & Jane, 1985; Boll, 1983; Jennett, 1989) report that as many as 20% of injuries sustained by school age children go unwitnessed by adults, whereas anywhere from 20% to 40% of mild TBI cases are never reported, and no medical attention is sought. Conservative estimates, based only on those admitted to the hospital, suggest that as many as 158 per 100,000 children and adolescents sustain a mild brain injury annually (Segalowitz & Brown, 1991). Although persistent and troublesome sequelae of mild TBI may occur in only a small proportion of these cases, research and clinical attention to this problem is critical because the incidence of mild TBI in the pediatric population is so great (Beers, 1992). Any reduction in morbidity would represent a vast savings to health costs and human suffering (Harrington, Malec, Cicerone, & Katz, 1993).