Investigators from UMDNJ-New Jersey Medical School, Newark, NJ, studied the cause, course, and outcomes of 757 patients who were admitted over 54 months following mild head injury (MHI) complicated by intracranial hemorrhage (ICH). Of these, 31 (4.1%) experienced delayed neurological deterioration (DND)(Glasgow Coma Scale score decrease >2); 87% deteriorated within 24 hours of admission, 68% had progressive ICH, 32% had medical causes for DND, and 23% died. Factors associated with mortality included age >60 years, coagulopathy, and change in Marshall CT classification. In adolescents and adults the incidence of DND is low but carries significant morbidity and mortality if it results from progressive ICH. [1]

COMMENTARY. This study shows that the majority (96%) of adult and adolescent patients with mild head injury plus ICH has a good prognosis and remains stable without neurological decline. In the 4% with delayed neurological deterioration, 87% deteriorated within the first 24 hours, mainly because of a progressive ICH. Coagulopathy is an important risk factor and the diagnosis and correction during transmission to a trauma center improves prognosis [2]. Since age (>60 years) is found to be a risk factor [3], children and adolescents may be expected to carry a low risk of delayed neurological deterioration. The following study, however, emphasizes a residual cognitive disability in TBI children aged 7-18 years.

Residual Cognitive Disability in Children with TBI. On admission to inpatient rehabilitation, patients with TBI had more cognitive disability than those with other injuries, and TBI patients had significant residual cognitive disability on discharge [4].