Hypothesis / aims of study
Acquired brain injury (ABI) in children is quite common. In severe ABI children are often operated by neurosurgeons,and admitted to an intensive care unit (ICU). During the emergency phase children are commonly managed with an indwelling catheter in ICU, that is removed after the acute phase when patient is admitted in a neurorehabilitation department. Incontinence, urinary and fecal, are common long-term sequelae in ABI. However bladder and bowel functions are considered commonly a secondary problem respect to more serious physical injuries and often managed with pads. For this reason incontinence is often neglected for weeks or months after ABI, due to striking disabilities, with a delay in diagnosis and management of bladder-bowel dysfunctions (BBD) while in a global process of rehabilitation also continence should be considered. Bladder and bowel dysfunctions (BBD) in children with spinal cord injuries (SCI) have been evaluated as in cerebral palsy (CP).Scant data are available in acquired brain injury (ABI). Aim of our study is to evaluate BBD risk and incidence in ABI children using no invasive methods.
Study design, materials and methods
All new patients admitted from the 1st July to the 30th September 2017, aged 3 to 18 years old, were evaluated. Data were collected considering clinical diagnosis, ICIQ Scale, Wee-Fim Scale, Bristol scale, Gross Motor Function Classification System (GMFCS) and the Communication Funcion Classification System (CFCS). Statistical analysis was performed with Microsoft SPSS,p<0,001 was considered significative.The study has been previously approved by our Research/Ethical Committee and all questionnaires, diaries, scale were administered after a written consent was obtained by relatives.
Results
64 new patients were admitted. 4 refused to partecipate, 60 have been included. 30 presented CP and 17 ABI, 3 SCI , 10 others congenital pathologies. About ABI patients none of them had never evaluated before by pediatric urologist.
Results are reported below:
D PTS UTI NUI U C DUI BD SF
CP 30 13,3% 60% 33,3% 23,3% 26,6% 53,3% 52%
ABI 17 23,5% 59% 35,2% 35,3% 11,7% 64,7% 54%
SCI 3 66,6% 100% 33,3% 66,6% 33,3% 33,3% 43%
OTHER 10 0% 70% 30% 20% 30% 70% 59%
D:diagnosis, PTS: patients, UTI: urinary tract infections ,NUI: night urinary incontinence, U:urgency,C: Crede', DUI: day urinary incontinence, BD: bowel dysfunctions, SF: self-care
No statistical difference is present between ABI and CP.
Interpretation of results
Incontinence is highly relevant as well as mobility considering the patient's quality of life, future school and social activities and affective relationship. This is true in all children with disabilities either in CP as in SCI as in ABI. While CP and SCI are well evaluated for BBD occurrence and relative management, this is missed in ABI. The purpose of our study has been to evaluate the occurrence of BBD in these children, because the majority of patients are still treated only with diapers or indwelling catheters for bladder, as enema and pads for bowel dysfunction, not considering the different clinical situation that can be related to ABI. It is realistic to suggest in a diagnostic tools the role of no invasive methods as questionnaires and diaries , using invasive studies in selected cases. An early diagnosis permits a correct use of anticholinergic, clean intermittent catheterization, cistostomy, in acute phase, preserving bladder and renal function. In this way the use of second or third line treatment , more invasive, could be reduced . A complete bowel management using advanced transanal irrigation can be considered in the majority. Anyway in children after ABI, an individual rehabilitation project, single patient related, has to be considered.