Paediatric TBI has lifelong implications for development, cognition, care needs and quality of life - directly shaping causation and quantum. This article expands on the webinar’s clinical guidance and expert‑witness perspectives.

Watch the full webinar with Mr Ibrahim Jalloh here ›

Growth Plate Injuries: Clinical Risks

(Note: Included to mirror common paediatric trauma pitfalls that intersect with head/spine assessment; adapt if not relevant to this neurosurgical topic.)

• In multisystem trauma, growth‑plate injury and cervical instability can be under‑recognised when focus centres on head injury alone.
• Maintain low thresholds for imaging where focal neurological signs (e.g., limb weakness, recurrent falls) are documented.

Medico‑Legal Considerations

• Guidelines adherence: Compare decision points against NICE head injury guidance (scan thresholds, escalation, deterioration protocols).
• Venue of care: Document rationale for (non‑)transfer to a Major Trauma Centre; evaluate impact on outcome.
• Secondary injury analysis: Track oxygenation, ICP management, and timeliness of interventions to identify avoidable harm.
• Causation & prognosis: Map acute events to long-term trajectories, including neurocognitive and behavioural outcomes often requiring input from child and adolescent psychologists, alongside endocrine, autonomic, and epilepsy risks extending decades into the future
• Expert evidence: Expect clear timelines, imaging interpretation, and reasoned projections for future care and life expectancy.

Case Examples & Outcomes

• Delayed imaging with focal deficits: Late diagnosis of intracranial or high‑cervical injury; worsened functional outcome; breach where criteria to scan were present.
• Missed deterioration: Failure to escalate after neurological decline; exacerbated secondary injury; stronger liability position.
• Non‑accidental injury (NAI) vs alternatives: In birth‑related trauma or subdural haemorrhage, weigh patterns against differential diagnoses (e.g., BESS) with specialist neuroradiology input.

Key Takeaways for Solicitors

• Treat paediatric TBI as a distinct entity - don’t transpose adult thresholds.
• Build a timeline of care from ambulance to ICU; link each departure from protocol to outcome.
• Verify imaging decisions and transfer pathways against standards.
• Evidence hidden morbidities, including cognition and language impairments often requiring assessment and intervention from speech and language therapists, alongside endocrine sequelae and autonomic dysfunction; revisit prognosis as the child matures.

Quote Highlights

“Children with head injury often have concurrent high cervical spine trauma - if you don’t look for it, you’ll miss it.”

“Growth plate injuries are some of the most frequently missed diagnoses in paediatric trauma.” (If kept, ensure relevance to the case mix presented.)

“Secondary brain injury is often preventable - records from the first hours can make or break causation.”

Mr Ibrahim Jalloh, MB ChB, MRCS, FRCS (Neuro.Surg) Consultant Paediatric Neurosurgeon, Cambridge University Hospitals NHS Foundation Trust

Access our panel of 41 Paediatric Neurosurgery Expert Witnesses >