Modelling early recovery patterns after paediatric traumatic brain injury

Area of Science:

• Neurology
• Rehabilitation Medicine
• Pediatrics

Background:

• Traumatic brain injury (TBI) in children necessitates inpatient rehabilitation.
• Understanding early recovery patterns is crucial for predicting functional outcomes.
• The WeeFIM scale is a validated measure of functional independence in children.

Purpose of the Study:

• To describe the range of early recovery patterns in pediatric TBI patients.
• To develop simple predictive models for expected recovery trajectories.
• To identify early indicators of recovery in children post-TBI.

Main Methods:

• Analysis of 103 pediatric admissions to a neurological rehabilitation facility post-TBI.
• Utilized repeated WeeFIM scores to construct recovery trajectories.
• Employed non-linear mixed effects modeling to define typical recoveries and identify predictors.

Main Results:

• WeeFIM recovery curves exhibited a sigmoidal pattern: slow initial phase, rapid mid-phase improvement, and plateau.
• Final WeeFIM scores varied widely (median 105), with significant range in time to reach 50% of final score (median 27 days).
• Time to follow commands (TFC) correlated with final WeeFIM scores and time to reach 50% improvement, serving as a key predictor.

Conclusions:

• Simple predictive models for pediatric TBI recovery can be developed using early recovery indices like TFC.
• These models facilitate informed discussions with families regarding expected recovery rates and confidence intervals.
• Such models can aid in identifying children with better- or worse-than-expected recovery trajectories.