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Childhood morbidity after severe traumatic brain injury: Increased detection with the Multiattribute Health Status
Charlene M. T. Robertson1, Joe M. Watt, Ari R. Joffe
1Departments of Pediatrics and Rehabilitation Medicine (Drs. Robertson, Watt, Murphy, Nagy, McLean, and Pain), Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada; and the Department of Pediatrics (Drs. Robertson, Watt, and Joffe) and Department of Public Health Sciences (Dr. Saunders), University of Alberta, Edmonton, Alberta, Canada.
Insights
The Multiattribute Health Status Classification (MAHSC) shows high reliability for assessing outcomes in children with severe traumatic brain injury (TBI). This parent-reported tool identified significant health issues not captured by other measures, indicating most children experience adverse outcomes after TBI.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Neurotraumatology
Background:
- Childhood traumatic brain injury (TBI) is a significant cause of long-term disability.
- Accurate outcome assessment is crucial for effective management and rehabilitation of pediatric TBI survivors.
- Existing outcome measures may not fully capture the multifaceted impact of TBI on children's health status.
Purpose of the Study:
- To evaluate the interrater reliability of the Multiattribute Health Status Classification (MAHSC) in children with brain injuries.
- To compare the efficacy of MAHSC against the Functional Independence Measures (FIM/WeeFIM) and the Glasgow Outcome Scale in assessing severe TBI outcomes.
- To identify the long-term health status and outcomes of children following severe TBI.
Main Methods:
- Study 1 involved two physiatrists and parents of 50 children with brain injuries independently completing the MAHSC.
- Study 2 followed an inception cohort of 51 children with severe TBI (Glasgow Coma Score ≤ 8), with parents completing outcome measures (MAHSC, FIM/WeeFIM, Glasgow Outcome Scale) at 6-12 months post-injury.
- Statistical analyses included interrater agreement calculations, correlation coefficients between measures, and sensitivity/specificity analyses for predictors of outcome.
Main Results:
- The MAHSC demonstrated high interrater agreement (>70%) for various health attributes in Study 1.
- In Study 2, only 18% of survivors had normal MAHSC attributes, compared to 36% on FIM/WeeFIM and 76% with a 'good recovery' on the Glasgow Outcome Scale.
- The MAHSC showed strong correlations with both the Glasgow Outcome Scale (-.73) and FIM/WeeFIM (-.63), and offered better sensitivity and specificity in predicting outcomes than FIM/WeeFIM.
Conclusions:
- The MAHSC is a reliable parent-report tool for auditing outcomes in children with severe TBI.
- The MAHSC identifies critical health problems in TBI survivors that may be overlooked by the Glasgow Outcome Scale and FIM/WeeFIM.
- A significant proportion of children with severe TBI experience persistent adverse health outcomes, highlighting the need for comprehensive assessment tools like MAHSC.
Abstract:
OBJECTIVES: Study 1: To determine the interrater agreement on the Multiattribute Health Status Classification (MAHSC) for brain-injured children. Study 2: To determine the outcome of severe childhood traumatic brain injury (TBI) by comparing three measures: MAHSC, Functional Independence Measures (FIM/WeeFIM), and the Glasgow Outcome Scale. Designs: Study 1: Clinic recruitment of parents of patients. Study 2: Surveillance follow-up of an inception cohort. Settings: Study 1: The Brain Injury Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada. Study 2: Pediatric Intensive Care Unit, University of Alberta Hospital. PATIENTS: Study 1: Two physiatrists and parents of 50 children (5-18 yrs, 54% boys) independently completed the survey. Study 2: From a cohort of 51 patients (3-17 yrs, 69% boys, 6 deaths) consecutively admitted to the pediatric intensive care unit in 1995 and 1996 with severe TBI (Glasgow Coma Score