Paediatric Traumatic Brain Injury: Mr Ibrahim Jalloh Shares His Medico-Legal Expertise

Ardent Expert Chambers Member Mr Ibrahim Jalloh, Consultant Adult and Paediatric Neurosurgeon, joined INNEG for a specialist webinar examining the clinical and medico-legal complexities of paediatric traumatic brain injury.

Drawing on his experience in adult and paediatric neurosurgery, Mr Jalloh explored why brain injury in children requires a distinct clinical approach, how secondary neurological damage may develop following the initial trauma, and the importance of examining the complete pathway of care when forming an expert opinion.

The session demonstrated the breadth of specialist knowledge required when assessing complex paediatric brain and spinal injury cases, particularly where questions arise around imaging, escalation, transfer, neurological outcome and long-term prognosis.

Why Paediatric Brain Injury Requires a Different Approach

A central theme of Mr Jalloh’s webinar was that children cannot simply be treated as smaller versions of adults when assessing traumatic brain injury.

The developing brain responds differently to trauma, and the mechanisms, clinical thresholds and potential consequences of injury may differ considerably from those seen in an adult population.

Age, stage of development and the nature of the trauma can all influence presentation, investigation and outcome.

For an expert witness reviewing a paediatric TBI case, this makes specialist paediatric experience particularly important. Clinical decisions must be considered against the standards and challenges specific to the treatment of children rather than applying adult neurological frameworks without adjustment.

Imaging, Assessment and Escalation

Mr Jalloh also explored the role of imaging and clinical escalation following paediatric head injury.

Decisions around neurological observation, CT imaging and further investigation often depend on a combination of the mechanism of injury, clinical presentation and recognised guidance.

When providing medico-legal opinion, the relevant question is not simply whether an abnormality was eventually identified.

An expert may need to consider whether imaging was indicated at an earlier stage, whether changes in neurological presentation should have prompted further assessment and whether escalation was appropriate in light of the information available to the treating clinicians at the time.

This requires detailed review of the contemporaneous records and the clinical progression of the child.

Considering the Head and Spine Together

Another important theme was the relationship between paediatric head trauma and cervical spinal injury.

Significant head injury can coexist with injury to the upper cervical spine, meaning that assessment may need to extend beyond the brain itself.

Mr Jalloh discussed the importance of recognising this relationship and ensuring that neurological and spinal findings are considered together where the mechanism of trauma raises concern.

His combined expertise in brain and spinal conditions allows him to assess cases in which the boundaries between neurosurgical injuries are not always straightforward.

Primary and Secondary Brain Injury

Mr Jalloh also distinguished between the damage caused by the initial trauma and secondary neurological injury that may develop afterwards.

Factors including hypoxia and raised intracranial pressure can compound the effects of the original injury and may have significant implications for neurological outcome.

This means that a medico-legal review may extend across several stages of care, from pre-hospital treatment and emergency assessment through to intensive care and specialist neurosurgical management.

An expert may need to assess not only the original injury but also whether subsequent deterioration was recognised and managed appropriately, and what contribution any secondary insult may have made to the final neurological picture.

Transfer and Specialist Neurosurgical Care

The location and timing of treatment can also become important in severe paediatric trauma.

Mr Jalloh discussed the circumstances in which a child may require transfer to a Major Trauma Centre or specialist neurosurgical service, particularly where the injury becomes more complex or the child's condition deteriorates.

From an expert perspective, reviewing such a case can involve consideration of the clinical information available at the point of transfer decisions, the facilities and expertise available locally and whether specialist involvement was sought at an appropriate stage.

His experience across both adult and paediatric neurosurgery provides a broad perspective on the management of severe traumatic brain and spinal injury across different stages of the care pathway.

Understanding Long-Term Neurological Outcome

A child's outcome following traumatic brain injury cannot always be understood through physical recovery alone.

Mr Jalloh highlighted the potential for longer-term consequences including cognitive and language difficulties, endocrine dysfunction, autonomic disturbance and an increased risk of epilepsy.

Some effects may also become more apparent as a child develops and the demands placed upon cognitive and neurological function increase.

This makes long-term prognosis particularly complex in paediatric cases.

When providing expert evidence, Mr Jalloh’s role may therefore extend beyond analysing the acute injury to considering the child's ongoing neurological condition and the potential implications for future development.

Expertise in Complex Paediatric Brain and Spinal Injury

Mr Jalloh is a Consultant Adult and Paediatric Neurosurgeon with specialist expertise spanning traumatic brain injury, brain tumours, hydrocephalus, spinal surgery, spinal cord injury, spina bifida and Chiari malformation.

He has undertaken medico-legal work since 2019, with approximately seven years of expert witness reporting experience, and prepares around ten reports each year across Claimant, Defendant and joint instructions.

His medico-legal work includes opinions addressing screening, breach of duty, causation, condition and prognosis in both Clinical Negligence and Personal Injury matters.

His webinar with INNEG provided an opportunity to demonstrate the specialist reasoning required when assessing complex paediatric neurological injury, from the circumstances of the initial trauma and acute management through to secondary injury and long-term outcome.

Mr Ibrahim Jalloh is a member of Ardent Expert Chambers. View his full member profile to learn more about his specialist expertise and medico-legal practice.

Watch Mr Ibrahim Jalloh’s Paediatric Traumatic Brain Injury webinar on the INNEG Resource Centre >