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The Westmead Pediatric TBI Multidisciplinary Outcome study: use of functional outcomes data to determine resource
S J O'Flaherty1, A Chivers, T J Hannan
1Department of Paediatrics, Westmead Hospital, Sydney, Australia.
Insights
Children with severe traumatic brain injury (TBI) experience lasting functional deficits. A new TBI severity classification system may aid in resource allocation for pediatric TBI rehabilitation.
Area of Science:
- Pediatric Traumatology
- Neurorehabilitation
- Child Neurology
Background:
- Traumatic brain injury (TBI) significantly impacts children's functional outcomes.
- Assessing TBI severity is crucial for effective resource allocation in pediatric care.
Purpose of the Study:
- To evaluate functional outcomes two years post-TBI in children.
- To assess the utility of a TBI severity classification system for resource allocation.
Main Methods:
- Prospective inception cohort study at a tertiary pediatric trauma center.
- Included 81 children (0-14 years): 51 with TBI (Mild/Severe) and 30 controls.
- Assessed cognition, communication, motor skills, self-care, and academic performance.
Main Results:
- Mild TBI group showed no significant deficits at 2 years.
- Severe TBI group exhibited persistent deficits in fine motor skills, neurologic status, self-care, and academics.
- Control group outcomes were not detailed but implied to be normal.
Conclusions:
- A novel TBI severity classification system for children under 15 has been developed.
- This system may facilitate early allocation into severity groups for tailored rehabilitation.
- The classification system shows potential for prioritizing resource allocation in pediatric TBI care.
Objective:
To measure functional outcome in the 2 years after traumatic brain injury (TBI) in 2 groups of children and to determine the usefulness of a TBI severity classification system for resource allocation.
Design:
Prospective inception cohort study with 3 assessment points during the 2 years after trauma.
Setting:
Tertiary pediatric trauma center in Sydney, Australia.
Participants:
Eighty-one consecutive admissions aged 0 to 14 years. Fifty-one were allocated to the Mild (n = 26) or Severe (n = 25) TBI groups, according to preset determinants of severity; 30 admissions with non-TBI trauma constituted the control group.
Main Outcome Measures:
Standardized psychometric and clinical assessments of cognition, communication and feeding ability, motor performance (ambulation, fine and gross motor), neurologic status, self-care independence, and school/academic performance.
Results:
Those with Mild TBI severity had no significant deficits at the 2-year data point. In contrast, those in the Severe TBI group demonstrated continued problems with fine motor performance, neurologic status, self care, and school/academic performance.
Conclusions:
A classification system has been developed that may be useful in the allocation of children with a TBI, age younger than 15 years, to 1 of 2 severity groups early in their rehabilitation. This classification system may be useful in determining areas of high and low resource prioritization.