Head injuries sustained by children could cause long-term injuries such as disability and psychiatric problems, paediatricians tell Jennifer Grech.

Blows to the head suffered when young may increase the risk of a blighted or shortened life. Photo: Shutterstock.com

Maltese doctors are highlighting the importance of head injury prevention as research suggests blows to the head suffered when young may increase the risk of a blighted or shortened life.

A large-scale study, published in the journal Public Library of Science Medicine last week, showed that even apparently mild head injuries could have potentially devastating long-term effects, including an increased risk of disability, psychiatric problems, low educational attainment and even early death.

Many of those affected will have sustained traumatic brain injury (TBI) while playing contact sports such as football, rugby or boxing.

Local statistics show that between January and June this year, there have been 127 episodes of patients, in the age bracket of one to 16 years, admitted to Mater Dei with a head injury diagnosis. In 2015, records show 262 people suffered such injuries.

But scientists stressed the low absolute risk of being hit on the head and experiencing such repercussions, and said a balance had to be struck between the benefits and hazards of sport.

“This study is unsurprising as we have long known that any head injury may cause long-term mental health problems,” Victor Grech, consultant paediatrician (cardiology) at Mater Dei Hospital said.

“However, this paper neatly summarises the absolute and relative chances of such long-term problems.”

Researchers used registries to study the progress of more than a million Swedes born between 1973 and 1985 up to the age of 41.

If you look at the absolute risks, they can be reduced by appropriate safety precautions

In total, 9.1 per cent were found to have suffered at least one TBI caused by a blow to the head before their 25th birthday.

The types of injury ranged from mild knocks that left a person temporarily dazed without losing consciousness, to serious brain damage leading to a lengthy stay in hospital.

To be included in the study, every patient had to have undergone an “alteration of consciousness” and received a hospital assessment.

Compared with people who had not experienced a head injury, these individuals were 76 per cent more likely to have qualified for disability payments, meaning they could not work.

They were also 58 per cent more likely to have achieved a low level of education, almost twice as likely to have been taken to hospital for a psychiatric problem, and 72 per cent more likely to have died prematurely before the age of 41.

Multiple brain injuries significantly increased the risks, as did experiencing a TBI at an older age.

“This study therefore highlights the importance of injury prevention. Rules pertaining to helmets and wearing of seat belts must be enforced, not only for the sake of the individual but also for  the State being  that it will have to carry the financial burden of care for such unfortunate damaged individuals for life,” stressed Grech.

Charles Borg, another paediatrician at Mater Dei, urged parents to allow children to participate in sport but laid emphasis on the importance of precautions so as to reduce the chances of serious injury.

“I think with everything in life there are risks and benefits. If you look at the absolute risks, they can be reduced by appropriate safety precautions,” he said.

Head injuries are known to have a primary phase caused by the initial physical damage to nerve cells, and a longer lasting secondary phase linked to inflammation and toxins released into the brain. Scientists are still trying to understand the ongoing effects, which may continue to kill off neurons for years.

The research could have implications for designing school playgrounds and safety equipment such as helmets, and perhaps even the rules of certain contact sports, it is claimed.

Their message was clear: circumstances that could cause injuries, such as sport, have benefits as well as risks. The absolute risks are not that huge and the benefits of sport to health must not be forgotten.

What is a brain injury?

Traumatic brain injury (TBI) refers to damage to the brain caused by an external physical force such as a car accident, a gunshot wound to the head, or a fall. A TBI is not caused by something internal such as a stroke or tumour, and does not include damage to the brain due to prolonged lack of oxygen (anoxic brain injuries). It is possible to have a TBI and never lose consciousness.

Commonly accepted criteria established by the TBI Model Systems (TBIMS) to identify the presence and severity of TBI include:

Damage to brain tissue caused by an external force and at least one of the following:

• A documented loss of consciousness

• The person cannot recall the actual traumatic event (amnesia)

• The person has a skull fracture, post-traumatic seizure, or an abnormal brain scan due to the trauma