Functional outcome in children with traumatic brain injury. Agreement between clinical judgment and the functional
C Di Scala1, C C Grant, M M Brooke
1Department of Rehabilitation Medicine, Tufts/New England Medical Center, Boston, MA 02111.
Insights
Children hospitalized for traumatic brain injury face significant disability, with severity correlating to injury scores and expected recovery time. Early assessment of functional impairments is crucial for long-term care planning.
Area of Science:
- Pediatric Traumatology
- Neurorehabilitation
- Child Health Services Research
Background:
- Improved trauma care increases survival rates, necessitating evaluation of long-term morbidity in pediatric injury survivors.
- Children with traumatic brain injury (TBI) often have complex and prolonged medical and psychosocial needs.
- Assessing disability is essential for planning appropriate support services for children recovering from TBI.
Purpose of the Study:
- To assess the disability and functional impairments in children and adolescents hospitalized for traumatic brain injury.
- To correlate injury severity and expected recovery time with functional outcomes at discharge.
- To inform the planning of medical and psychosocial services for pediatric TBI survivors.
Main Methods:
- A cohort of 598 children (ages 8-19) hospitalized for TBI (with or without other injuries, excluding spinal cord) were studied.
- Disability was measured at discharge using nine functional activity areas and clinician-assigned recovery time.
- Injury severity was assessed using the Glasgow Coma Scale (GCS) and Injury Severity Score (ISS); functional outcomes were measured by the Functional Independence Measure (FIM).
Main Results:
- Clinician-assigned recovery time (categorized as <7 months, 7-24 months, >2 years) significantly correlated with GCS and ISS scores (P<0.01).
- Higher injury severity (lower GCS, higher ISS) was associated with longer expected recovery times and greater functional impairments at discharge.
- Group C (expected recovery >2 years) showed the highest percentage of severe injuries (84% ISS), comatose admissions (58% GCS), and multiple impairments (84%), with the lowest FIM scores (average 58).
Conclusions:
- Injury severity, as measured by GCS and ISS, is a significant predictor of expected recovery time and functional disability in pediatric TBI patients.
- A substantial proportion of children experience significant functional impairments at discharge, highlighting the need for comprehensive, long-term rehabilitation and support.
- The findings underscore the importance of early and accurate assessment of disability to guide individualized care plans for children recovering from traumatic brain injury.
Abstract:
As improvements in the delivery of trauma care have increased survival from injury, it has become essential to assess the resulting morbidity to plan for medical and psychosocial services, particularly for children whose needs may be wide and long term. This paper focuses on the assessment of disability of 598 children, age 8 to 19 yr, hospitalized for traumatic brain injury with or without injury to other body regions, exclusive of spinal cord injury. The disability was measured at discharge from acute care in nine areas of functional activities and a recovery time assigned by a clinician. For the study, children were divided into three groups: those whose recovery was expected in less than 7 months (Group A: n = 463), in 7 to 24 months (Group B: n = 66) and in greater than 2 yr (Group C: n = 69). The clinician's expectation of recovery time significantly (P less than 0.01) reflected the injury severity as measured by the Glasgow Coma Scale and the Injury Severity Score. By the Glasgow Coma Scale, 16.4% were comatose on admission in Group A, 51.5% in Group B and 58% in Group C. The Injury Severity Score was significantly different with 25.5% severely injured in Group A, 68.2% in Group B and 84% in Group C. At discharge, 15% in Group A had four or more areas of impairments, 61% in Group B and 84% in Group C. The Functional Independence Measure confirmed the clinician's assessment of compromise with significantly (P less than 0.01) different average values of 110, 80 and 58 for Groups A, B and C, respectively.
