６歳以下で交通事故による重症脳外傷を受傷した19例の長期予後

抄録

Objective: Traumatic brain injury (TBI) resulting from a traffic accident is not so common in young children. We reviewed our experience to clarify the status for further medical care.

Methods: Nineteen patients aged under 7 years with severe TBI caused by traffic accidents underwent inpatient rehabilitation in our hospital between 1993 to 2010, and were followed up until after age 18 years. We retrospectively investigated the causes of injury, treatment during the acute stage, and outcomes including physical disability, intellectual disability, higher brain dysfunction, and epilepsy, and family functioning. The patients were divided into 4 groups by outcome: group I (7 cases) were independent, group II (2 cases) participated in "employment of persons with disabilities", group III (6 cases) had employment that required support, and group IV (4 cases) required full assistance for all activities of daily life. Clinical factors were compared between the 4 groups. The change in severity for each patient at 7, 13, and 18 years of age was assessed.

Results: Average age at injury was 5 years in all 4 groups. Many accidents such as jumping into the road, not wearing seat–belt, and so on seemed to be preventable by adult intervention. The outcome worsened depend­ing on the depth and extent of loss of consciousness. Contusion was most prominent type of brain injury in all groups. Focal damage was prominent and diffuse damage was not seen in group IV. No infarction was found in groups I and II. Neurosurgical treatment was prominent in groups III and IV. Limited help for higher brain dysfunction was required in group I. Some support for higher brain dysfunction and mild mental disability was necessary in group II. Individual support programs for intellectual disability and higher brain dysfunction were necessary in group III. Full support for all daily life was essential in group IV. The severity of disability was gradually im­proved in most patients, but a few in group III showed regression due to intractable epilepsy and bad family functioning.

Conclusion: Nineteen young patients with severe TBI caused by traffic accident were examined. Prevention of traffic accidents is the most im­portant intervention. Moreover, good programs to support higher brain dysfunction and family care are the keys to better outcome.