Long-term Outcome After Severe Brain Injury in Preschoolers Is Worse Than Expected

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Abstract
Objective: To determine the long-term outcome after severe brain injury at preschool age. Design: Follow-up until adult life. Setting: A centralized guidance center for all trafficassociated injuries. Patients: Children with severe brain injury at preschool age between January 1959 and December 1969. Main Outcome Measure: Final evaluation in adulthood was performed by our team. The capability to work and live independently was rated. Results: Twenty three (59%) of 39 children attended a typical school, eight (21%) attended a school for the physically disabled, and seven (18%) attended a school for the mentally retarded; information was not available for one child. In adulthood, nine patients (23%) were able to work full-time, 10 (26%) worked at sheltered workplaces, 14 (36%) lived independently at home, and six (15%) needed physical and/or psychotherapeutic support. The difference between normal school performance (59%) and capability to work full-time (23%) was significant (P<.05). In evaluating different aspects after the severe brain injury, the sense of identity was the best indicator of final outcome. Conclusions: The final evaluation of severe brain injury at preschool age should be performed in adulthood. Normal school performance or normal intelligence functioning is not a guarantee for good long-term prognosis. To let the child develop a firm identity is essential for good outcome. (Arch Pediatr Adolesc Med. 1995;149:249-254)

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