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Predictors of outcome following traumatic brain injury in young children
Mary R Prasad1, Linda Ewing-Cobbs, Paul R Swank
1Department of Pediatrics, University of Texas Health Science Center, Houston, TX 77030, USA. Mary.R.Prasad@uth.tmc.edu
Insights
Clinical and neuroimaging factors significantly predict outcomes in young children with traumatic brain injury (TBI). Inflicted TBI and pupillary issues indicate poorer GOS, cognitive, and motor scores.
Area of Science:
- Pediatric neurology
- Neurotraumatology
- Child brain injury research
Background:
- Traumatic brain injury (TBI) in young children presents complex challenges in predicting long-term outcomes.
- Understanding the interplay between clinical presentation, neuroimaging findings, and functional recovery is crucial for effective management.
- Distinguishing between inflicted and non-inflicted TBI is vital due to differing prognoses.
Purpose of the Study:
- To investigate the relationship between clinical and neuroimaging variables and multiple outcome measures in children under 6 with traumatic brain injury.
- To identify predictors of Glasgow Outcome Scale (GOS), cognitive, and motor scores at various time points post-injury.
- To assess the impact of inflicted versus non-inflicted brain injury on neurodevelopmental outcomes.
Main Methods:
- A longitudinal, prospective study involving 60 children under 6 years of age with traumatic brain injury.
- Hierarchical multiple regression analysis to determine the variance accounted for by clinical and neuroimaging variables.
- Evaluation of outcomes including Glasgow Outcome Scale (GOS), cognitive, and motor scores at baseline, 3 months, and 12 months post-injury.
Main Results:
- Modified Glasgow Coma Scale score, duration of impaired consciousness, and number of intracranial lesions on CT/MRI significantly predicted GOS, cognitive, and motor scores.
- Inflicted brain injury was associated with poorer GOS and cognitive outcomes.
- Pupillary abnormalities correlated with worse motor outcomes.
- Age at injury and Injury Severity Score did not significantly predict outcome variability.
Conclusions:
- Clinical and neuroimaging findings are significant predictors of functional outcomes in young children following traumatic brain injury.
- Inflicted traumatic brain injury confers a worse prognosis for cognitive and overall functional recovery.
- Early identification of specific clinical indicators like pupillary abnormalities can help anticipate motor deficits.
Abstract:
The relationship between clinical and neuroimaging variables and multiple outcome measures was examined in a longitudinal, prospective study of 60 children less than 6 years of age who sustained either inflicted or noninflicted traumatic brain injury. Hierarchical multiple regression indicated that the modified Glasgow Coma Scale score, the duration of impaired consciousness and the number of intracranial lesions visualized on CT/MRI accounted for a significant amount of the variance in the Glasgow Outcome Scale (GOS), cognitive and motor scores at baseline, 3- and 12-month evaluations. Inflicted brain injury adversely affected both GOS and cognitive outcomes. Pupillary abnormalities were associated with poorer motor outcome. Neither age at injury nor the Injury Severity Score accounted for significant variability in outcomes.
