Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. 749-758 (doi:10.1542/peds.2006-1186)
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ARTICLE

Previous Head Injury Is a Risk Factor for Subsequent Head Injury in Children: A Longitudinal Cohort Study

Bonnie R. Swaine, PhDa,b,c, Camille Tremblay, MScc, Robert W. Platt, PhDd,e, Guy Grimard, MDb,f, Xun Zhang, PhDe and I. Barry Pless, MDd,e

a School of Rehabilitation
b Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
c Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation de Montréal, Montréal, Québec, Canada
d Departments of Pediatrics and Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
e McGill University Health Centre, Montréal Children's Hospital Research Institute, Montréal, Québec, Canada
f Hôpital Ste-Justine, Montréal, Québec, Canada

OBJECTIVE. The objective of this study was to determine whether children who sought care for a head injury were at greater risk of having a subsequent head injury within the following 6 and 12 months compared with children who sought care for an injury other than to the head.

DESIGN/SETTING. This was a longitudinal cohort study conducted in the emergency departments of 2 Montreal (Quebec, Canada) pediatric hospitals.

PARTICIPANTS. The parents of 11867 injured children aged 1 to 18 years were interviewed by telephone at 6 (n = 10315) and 12 (n = 9486) months after their child's injury to ascertain outcome (ie, subsequent head injury) and to provide information on potential risk factors (age, gender, chronic medical condition, activity level, and socioeconomic status).

MAIN OUTCOME MEASURE. The outcome of interest was a head injury requiring medical attention within the following year ascertained by parental recall or physician claims data.

RESULTS. A total of 245 and 386 previously head-injured children sustained a subsequent head injury within 6 and 12 months, respectively. Children who sought care for an initial head injury (n = 3599) were at higher risk of having a subsequent head injury within 6 months than children who sought care for an injury not to the head (n = 6716). The adjusted odds ratio suggested weak confounding by age, gender, and history of previous head injury. Results were consistent on the basis of physician claims data and 12-month follow-up interview data.

CONCLUSIONS. These results provide evidence that having a head injury increases a child's risk of having a subsequent head injury. Although age, gender, and history of previous head injury confound the relationship, the effect remains substantial.

Key Words: children • recurrence • injury • head trauma • rehabilitation

Abbreviations: HI—head injury • ED—emergency department • CHIRPP—Canadian Hospital Injury Research and Prevention Program • RAMQ—Régie de l'assurance-maladie du Québec • SES—socioeconomic status • CI—confidence interval • OR—odds ratio • aOR—adjusted odds ratio

Accepted Dec 13, 2006.


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