Prevalence of Brain Injuries among Children with Special Healthcare Needs.

OBJECTIVES: To investigate differences in brain injury prevalence among US children by special healthcare needs status, accounting for sociodemographic and family characteristics, and to examine correlated health conditions among children with special healthcare needs (CSHCN). STUDY DESIGN: We conducted cross-sectional analyses using parent/caregiver responses to the 2016 National Survey of Children's Health (n = 50 212 children). CSHCN status was based on responses to a 5-item tool designed to identify children through assessment of functional limitations, prescription medication use, elevated service use or need, use of specialized therapies, and ongoing emotional, developmental, or behavioral conditions. Brain injury history was reported by parents/caregivers based on healthcare provider diagnosis. Bivariate and multivariable analyses were conducted. RESULTS: Lifetime history of brain injury was significantly higher among CSHCN than non-CSHCN (6.7% vs 2.3%, P < .001). CSHCN make up 19% of the total US child population but comprise 42% of children with lifetime brain injuries. In addition, the prevalence of a number of comorbid conditions and functional limitations was significantly higher among CSHCN with lifetime brain injury vs those without brain injury. CONCLUSIONS: The prevalence of lifetime history of brain injury is nearly 3 times greater among CSHCN than among non-CSHCN. Several comorbid conditions among CSHCN are significantly associated with lifetime history of brain injury. Further studies are needed to examine the extent to which brain injury in CSHCN may exacerbate or be misdiagnosed as other comorbid conditions.

Comparing prevalence estimates of concussion/head injury in U.S. children and adolescents in national surveys.

BACKGROUND AND OBJECTIVES: Reports on pediatric lifetime concussions/head injuries (LCHI) from national surveys have offered estimates on prevalence that range from 2.5% to 18% in the general population. The purpose of this study is to examine national surveys to compare methodologies and limitations pertaining to LCHI data collection. METHODS: Three nationally representative surveys that measure LCHI in children, including the National Survey of Children's Health, the National Health Interview Survey, and the Monitoring the Future Survey were examined. Children were grouped by ages 3-17 years and adolescent ages 13-17 years, stratified by selected demographic characteristics. Participants in the surveys included parents (NSCH and NHIS) and adolescents (MTF survey). The primary outcome measure is an estimate of LCHI in children. RESULTS: Estimates of prevalence of LCHI ranged from 3.6% to 7.0% for children ages 3-17 years and from 6.5% to 18.3% for adolescents 13-17 years. Survey modality, question wording, and respondent may contribute to differing estimates. Prevalence showed consistent variation by age, sex, and race/ethnicity across surveys. Associations were inconsistent between LCHI and insurance status, parental education, and household primary language. CONCLUSIONS: Although there are methodological differences in capturing pediatric LCHI across surveys, the prevalence estimates and correlational associations generated can offer awareness about the burden of these injuries and insights to research and clinical care.

Neurological effects of blast injury.

Over the last few years, thousands of soldiers and an even greater number of civilians have suffered traumatic injuries due to blast exposure, largely attributed to improvised explosive devices in terrorist and insurgent activities. The use of body armor is allowing soldiers to survive blasts that would otherwise be fatal due to systemic damage. Emerging evidence suggests that exposure to a blast can produce neurologic consequences in the brain but much remains unknown. To elucidate the current scientific basis for understanding blast-induced traumatic brain injury (bTBI), the NIH convened a workshop in April 2008. A multidisciplinary group of neuroscientists, engineers, and clinicians were invited to share insights on bTBI, specifically pertaining to: physics of blast explosions, acute clinical observations and treatments, preclinical and computational models, and lessons from the international community on civilian exposures. This report provides an overview of the state of scientific knowledge of bTBI, drawing from the published literature, as well as presentations, discussions, and recommendations from the workshop. One of the major recommendations from the workshop was the need to characterize the effects of blast exposure on clinical neuropathology. Clearer understanding of the human neuropathology would enable validation of preclinical and computational models, which are attempting to simulate blast wave interactions with the central nervous system. Furthermore, the civilian experience with bTBI suggests that polytrauma models incorporating both brain and lung injuries may be more relevant to the study of civilian countermeasures than considering models with a neurologic focus alone.