Related Experiment Video
Updated: Aug 11, 2026
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Health-related quality of life during the first year after traumatic brain injury
Melissa L McCarthy1, Ellen J MacKenzie, Dennis R Durbin
1Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. mmccarth@jhmi.edu
Insights
Children with moderate or severe traumatic brain injury (TBI) experience significant declines in health-related quality of life (HRQOL) for up to a year post-injury. Injury severity and associated factors are key drivers of this reduced HRQOL.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Rehabilitation Medicine
Background:
- Traumatic brain injury (TBI) is a significant cause of morbidity in children.
- Understanding the long-term impact of TBI on children's health-related quality of life (HRQOL) is crucial for effective management and rehabilitation.
- Previous studies have not fully elucidated the trajectory of HRQOL in the first year post-TBI and the factors influencing it.
Purpose of the Study:
- To document the health-related quality of life (HRQOL) of children following traumatic brain injury (TBI).
- To investigate the relationship between TBI severity and HRQOL within the first year after injury.
- To identify factors influencing HRQOL changes in pediatric TBI survivors.
Main Methods:
- A prospective cohort study was conducted across four pediatric level I trauma centers.
- 330 children with TBI were enrolled, with primary caregivers completing telephone interviews at baseline, 3 months, and 12 months.
- The Pediatric Quality of Life Inventory (PQLI) was used to measure HRQOL, with longitudinal, multivariable regression analyzing outcomes based on injury, patient, and family characteristics.
Main Results:
- A substantial proportion of children (42% at 3 months, 40% at 12 months) experienced impaired HRQOL post-TBI.
- Moderate to severe TBI led to significant, persistent declines in multiple HRQOL dimensions (3.7–17.6 decrease, P<.05).
- Lower extremity fractures, spinal injuries, pre-existing psychosocial conditions, impaired family functioning, lack of insurance, and single-parent households were associated with reduced HRQOL.
Conclusions:
- Moderate or severe TBI significantly impairs children's HRQOL in the year following injury.
- Injury-related factors demonstrated a greater impact on HRQOL than patient and family characteristics.
- These findings underscore the need for comprehensive care addressing both the physical and psychosocial sequelae of pediatric TBI.
Objectives:
To document health-related quality of life (HRQOL) of children with traumatic brain injury (TBI) and to examine the relationship between TBI severity and HRQOL during the first year after injury.
Design:
Prospective cohort study.
Setting:
Four pediatric level I trauma centers.
Patients:
Children with TBI (n = 330).
Main Exposure:
Traumatic brain injury.
Main Outcome Measures:
A primary caregiver completed telephone interviews at baseline, 3 months, and 12 months to measure the child's HRQOL using the Pediatric Quality of Life Inventory. The HRQOL outcomes were modeled as a function of injury, patient characteristics, and family characteristics using longitudinal, multivariable regression.
Results:
A considerable proportion of children had impaired HRQOL at 3 months (42% of children) and 12 months (40% of children) after injury. Multiple dimensions of HRQOL were negatively affected among children with moderate or severe TBI (decrease of 3.7 to 17.6) (P<.05) and did not improve significantly over time. Concomitant lower extremity fractures and spinal injuries resulted in large declines in overall HRQOL, particularly at 3 months after injury (decrease of 12.9 and 8.1, respectively) (P<.05). The HRQOL scores were also reduced by preexisting psychosocial conditions (decrease of 2.9 to 12.3), impaired family functioning (decrease of 5.1 to 6.8), having Medicaid coverage or being uninsured (decrease of 3.1 to 5.5), and single-parent households (decrease of 3.2 to 3.4) (P<.05).
Conclusions:
Moderate or severe TBI resulted in measurable declines in children's HRQOL after injury. Injury-related factors impacted HRQOL more compared with patient and family characteristics during the first year after injury.
