Children who suffer a traumatic brain injury, including mild concussion from a blow to the head, are less likely to do well at school and are at increased risk of early death, researchers have revealed.

As adults they are also more likely to receive a disability pension, have failed to gain secondary school qualifications and nearly twice as likely to have been hospitalised for psychiatric reasons.

The team analysed data from more than a million people born between 1973 and 1985, finding that around 9% had been diagnosed with at least one traumatic brain injury before the age of 25. More than 75% of these were mild injuries.

The researchers compared the outcomes for these individuals with those of others who had not experienced a head injury, as well as carrying out a second comparison, where possible, with siblings who had not been injured.

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Once factors such as age and sex were taken into account, the team found that those diagnosed with a traumatic brain injury have an increased risk of experiencing a number of health and social problems. Those who had suffered a traumatic brain injury were 76% more likely to receive a disability pension, 58% more likely to have failed to gain secondary school qualifications and nearly twice as likely to have been hospitalised for psychiatric reasons, compared to those who had sustained no injury.

When the researchers looked at patients who had siblings that had not sustained a traumatic brain injury, they found similar - although smaller - effects, suggesting that genetics could also play a role.



The study also indicates that more than one brain injury increases the risk of ill effects and that the older the child, the more profound the potential impact.

Writing in the journal PLOS Medicine, researchers from the UK, US and Sweden describe how they examined a number of Swedish national registries to explore how traumatic brain injuries could affect a variety of outcomes later in life.



“To summarise, we found that even a single mild traumatic brain injury will predict poor adult functioning,” said Amir Sariaslan, first author of the research from the University of Oxford.

Peter Jenkins, a neurologist from Imperial College, London who was not involved in the research, described the study as powerful. “I think clinically in healthcare at the moment we don’t necessarily recognise these persistent problems [and] we don’t necessarily have the resources available to help deal with those problems,” he said.

The study comes just five months after UK health experts called for a ban on tackling in school rugby games, citing a number of concerns including the risk of fractures and head injuries.

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But experts are quick to warn that the new study does not mean that parents should prevent their children from taking part in sports. “What we also know is that across a range of health-related conditions sport is very good for you,” said Alan Carson from the Centre for Clinical Brain Sciences at the University of Edinburgh, who was not involved in the study. He added that exercise is also good for the brain as it thought to reduce the risk of dementia.

The researchers say more should be done to prevent children and adolescents from experiencing head injuries, and to make sure that any problems arising from such an injury are picked up early on.



“[Design of] playgrounds, helmets, the use of helmets, even certain rules in certain collision sports may need to be thought about,” said Seena Fazel, co-author of the research from the University of Oxford. With many head injuries in young adults down to traffic accidents, messages around road safety and drink driving are also important, he added.

Researchers say that parents should seek medical advice if their child has received a blow to the head, or appears to be having problems at school following an injury. “There is some vigilance required when the injury is severe, or there are changes to the trajectory of your child,” said Fazel.

While it is not known exactly how traumatic brain injuries affect later outcomes, scientists have proposed a number of possible mechanisms, including damage to the brain’s neurons, changes to levels of chemicals in the brain and long-term inflammation of the brain. Other effects, such as interruptions in a child’s education due their need to take time off from school, could also play a role.

But, the researchers point out, while traumatic brain injuries appear to be linked to a increased risk of a number of problems, the chances of experiencing such issues are still low. “Most children will be unaffected,” said Fazel.

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For those who had not experienced a traumatic brain injury, the chances of an early death were just under 1%, while the chances of failing to achieve secondary school education was 9%. For those who had sustained an injury the figures were 1.6% and almost 14% respectively.

Peter McCabe, chief executive of brain injury charity Headway, said: “This research is a clear warning signal that the physical and psychosocial implications of brain injury can last a lifetime.”

McCabe says more support needs to be in place for those who have sustained traumatic brain injuries, and that teachers, social workers and GPs should all be aware of the possible effects.

“The often hidden effects of brain injury can make it difficult for people to get the diagnosis and help they need,” he said. “This is particularly the case in young people whose naturally developing personalities may mask any psychosocial changes following a traumatic brain injury.”