Long-term outcome after severe brain injury in preschoolers is worse than expected.
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 traffic-associated 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.