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Title:

Acquired Brain Injury in Childhood

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Acquired Brain Injury in Childhood Back to the beginning Anna Maw Consultant Paediatric Neurologist CUH/CPFT – PowerPoint PPT presentation

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Date added: 3 October 2019
Slides: 21
Provided by: CLAHRC2
Learn more at: http://www.clahrc-cp.nihr.ac.uk
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Title: Acquired Brain Injury in Childhood


1
Acquired Brain Injury in Childhood Back to the
beginning
  • Anna Maw
  • Consultant Paediatric Neurologist
  • CUH/CPFT

2
Overview
  • Acquired brain injury in childhood
  • Background to this project (what I thought I was
    going to learn)
  • Project method
  • Findings and thoughts
  • Where next ?

3
Acquired Brain Injury in childhood Background
  • Lifelong condition with lifelong implications
  • Recovery and rehabilitation have different aims
    in childhood back to normal is never enough
  • Many consequences remain hidden or unrecognised
    for many years silent disability

4
Acquired Brain Injury Complex needs in a
complex system
DEVELOPMENT
5
  • Who gets severe acquired brain injury?
  • How do they injure their brains?
  • What problems and deficits are they left with?
  • What is their service user journey?
  • What service needs do they have?
  • What is the best configuration of services to
    meet those needs?
  • www.inclusivedesigntoolkit.com

6
Paediatric Intensive Care Unit (PICU) Data
  • Aim to identify
  • children with first presentation of a condition
    which carries a significant risk of acquired
    brain injury.
  • PICU admission as a proxy marker of severity.
  • Admission data from 2007-2011
  • 2723 admissions
  • Phase 1 exclude all children with clearly
    unrelated conditions
  • Phase 2 exclude re-admissions, elective
    admissions, children who died on PICU and
    children with primary oncology diagnosis
  • Phase 3 group children into broad diagnostic
    categories
  • Phase 4 review electronic medical records, lab
    results, imaging CT, MRI of each case to ensure
    correct diagnosis. Further exclusions
  • Final cohort 253 children age 0-16
  • 154 boys, 99 girls

7
Acquired Brain Injury by diagnosis
8
  • Young patients
  • Very severely injured
  • High mortality 10 died
  • Global brain injury
  • High level of physical need
  • 13 of 19 patients are aged 2 or under.

9
  • Lancet Neurol. 2012 Sep11(9)774-83. Epub 2012
    Aug 3.
  • Outcomes of invasive meningococcal serogroup B
    disease in children and adolescents (MOSAIC) a
    case-control study.
  • Viner RM, Booy R, Johnson H, Edmunds WJ, Hudson
    L, Bedford H, Kaczmarski E, Rajput K, Ramsay M,
    Christie D
  • about a tenth have major disabling deficits
  • more than a third have one or more deficits in
    physical, cognitive, and psychological
    functioning, with the additional burden of memory
    deficits and executive function problems

10
Traumatic Brain Injury - 130 cases
11
  • 30 are under 1 year
  • 46 are age 4 or under
  • What do we tell them about the lifetime risk of
    problems?
  • How do we keep track of them over time?

12
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13
  • Who gets severe acquired brain injury?
  • How do they injure their brains?
  • What problems and deficits are they left with?
  • What service needs do they have?
  • What is their service user journey?
  • What is the best configuration of services to
    meet those needs?

14
  • Many thanks to
  • Andrew Bateman
  • Tony Holland
  • Fergus Gracey
  • Terry Dickerson
  • Cecily Morrison

15
Acquired Brain Injury Pathway for Children
Discuss with local team - named contact for each
locality
  • Initial high intensity nursing care
  • Ongoing specialist therapy input
  • Discuss with commissioners
  • Community Paediatrics
  • Neurology
  • Endocrine
  • CCPNR
  • Third sector
  • Adult services

ABI Passport
  • Assessment and Discharge Planning tool Pilot
  • MDT with 2-3 weeks notice, involving local team
  • CBIT child and family worker

16
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17
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18
  • Usually focal brain injury
  • May make a good early physical recovery
  • Risk of significant cognitive difficulties
  • Lots of research data on stroke
  • No reports in the literature relating to outcome
    following abscesses in children.

Persona samples
19
(No Transcript)
20
CLAHRC
  • NIHR Project
  • 9 collaborations around the country
  • research focused on the needs of patients and
    service users
  • to support the translation of research evidence
    into practice in the NHS
  • Emphasis on Mental Health
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