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Outcome rating scales for pediatric head injury
Stephen M Haley1, Robert J Graham, Helene M Dumas
1Health and Disability Research Institute, Boston University, Boston, Massachusetts 02215-1605, USA. smhaley@bu.edu
Insights
Assessing pediatric head injury outcomes requires standardized rating scales for mortality, recovery, and quality of life. No single scale is optimal, necessitating careful selection based on clinical needs and research goals.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Rehabilitation medicine
Background:
- Head injury significantly impacts pediatric patients' short- and long-term outcomes.
- Outcome assessment in pediatric intensive care units (PICUs) relies on various rating scales.
- Current literature lacks consensus on optimal outcome rating scales for pediatric head injury.
Purpose of the Study:
- To review and categorize existing rating scales for pediatric head injury outcomes.
- To inform the selection of appropriate scales for clinical management and research.
- To highlight key considerations for utilizing these scales in practice.
Main Methods:
- Systematic review of outcome rating scales reported in pediatric head injury literature.
- Categorization of scales into six classes: mortality prediction, severity, global recovery, activity restrictions, secondary adverse conditions, and participation/quality of life.
- Focus on scales assessing child outcomes, not family-reported measures.
Main Results:
- Rating scales are crucial for monitoring recovery, guiding treatment, and facilitating research in pediatric head injury.
- Scales are broadly classified into six outcome domains.
- No single rating scale is universally accepted as optimal for all clinical and research scenarios.
Conclusions:
- A comprehensive approach to outcome assessment in pediatric head injury is needed.
- Selection of rating scales should consider feasibility, data requirements, age range, recovery level, and impact on long-term outcomes.
- Further research and consensus-building are necessary to establish best practices for outcome measurement.
Abstract:
Intensivists, surgeons, neurologists, and others involved in pediatric intensive care units (PICUs) have an important investment in both short-and long-term outcomes of children and adolescents with head injury who are treated under their care. Outcomes are most often documented by either single- or multiple-item rating scales and are implemented both during and after hospital care. For this review, the authors have organized the content of rating scales into 6 general classes: (1) mortality prediction, (2) severity, (3) global recovery, (4) activity restrictions, (5) secondary adverse conditions, and (6) limitations in participation, quality of life, and health status. Rating scales that describe the outcomes of children and adolescents after head injury are used to monitor medical and functional recovery, guide clinical management, drive quality assurance initiatives, and conduct clinical research. The authors restrict their selective review to rating scales that describe child outcomes (vs family) and that have been reported and applied in the outcome literature. Although head injury is a major cause of mortality and short- and long-term morbidity in children and adolescents, there is no consensus on which rating scales are optimal for hospital care or community follow-up. Major considerations for clinical use are feasibility, type of outcome information needed, content breadth across multiple ages and levels of recovery, and utility in determining the short-term impact of PICU care on long-term outcome.
