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Long-term Outcome After Severe Brain Injury in Preschoolers Is Worse Than Expected-Reply

Marjaleena Koskiniemi, MD, PhD; Timo Kyykkä, MSc; Taina Nybo, MSc; Leo Jarho, MD, PhD
Arch Pediatr Adolesc Med. 1996;150(2):228. doi:10.1001/archpedi.1996.02170270110023.
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We very much appreciate the interest in our article shown by Vigil-Sewell and Sargent. We wish to comment on their arguments. First: What kind of patients could have been used as a control group? "Worse than expected" refers to the injured children themselves. Initial recovery and school performance give a more optimistic expectation of the late outcome than was shown when the outcome was assessed in adulthood. A selection bias is possible though improbable because in our health care system, all patients injured in motor vehicle–related accidents are referred to the Rehabilitationcentre's outpatient department (Kauniainen, Finland) for follow-up, even those children with expected full recovery, when the initial brain injury is considered severe. The final outcome was worse in children who were less than 4 years of age at the time of injury. This conclusion is based on the fact that none of those children were able to


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