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Persistence of disability 24 to 36 months after pediatric traumatic brain injury: a cohort study
Frederick P Rivara1, Monica S Vavilala, Dennis Durbin
1The Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.
Insights
Children with moderate to severe traumatic brain injury (TBI) show persistent functional deficits 36 months post-injury. No significant improvements in quality of life or participation were observed between 24 and 36 months.
Area of Science:
- Pediatric neurology
- Neuroscience
- Rehabilitation medicine
Background:
- Traumatic brain injury (TBI) is a significant cause of acquired disability in children.
- Long-term functional outcomes and recovery trajectories following pediatric TBI require further investigation.
Purpose of the Study:
- To evaluate functional outcomes 36 months after pediatric TBI.
- To assess changes in function between 24 and 36 months post-TBI.
- To compare outcomes in children with TBI to a control group with arm injuries.
Main Methods:
- Longitudinal study of children aged 0-17 years with TBI.
- Functional outcomes assessed using Pediatric Quality of Life Inventory (PedsQL), Adaptive Behavior Assessment Scale-2nd edition (ABAS-II), and Child and Adolescent Scale of Participation (CASP).
- Comparison with children treated for arm injuries as controls.
Main Results:
- Children with moderate or severe TBI had significantly lower PedsQL scores at 36 months compared to baseline.
- Poorer functioning on ABAS-II and reduced participation (CASP) were observed in moderate/severe TBI groups compared to baseline.
- No significant functional improvements were noted between 24 and 36 months across all groups.
Conclusions:
- Pediatric TBI, particularly moderate to severe injuries, results in persistent functional deficits up to 36 months post-injury.
- Current recovery trajectories suggest limited spontaneous functional improvement between 24 and 36 months.
- Development of targeted post-injury and preventive interventions is crucial to mitigate TBI's impact on children's function and quality of life.
Abstract:
This study examined the outcome of 0- to 17-year-old children 36 months after traumatic brain injury (TBI), and ascertained if there was any improvement in function between 24 and 36 months. Controls were children treated in the emergency department for an arm injury. Functional outcome 36 months after injury was measured by the Pediatric Quality of Life Inventory (PedsQL), the self-care and communication subscales of the Adaptive Behavior Assessment Scale-2nd edition (ABAS-II), and the Child and Adolescent Scale of Participation (CASP). At 36 months after TBI, those with moderate or severe TBI continued to have PedsQL scores that were 16.1 and 17.9 points, respectively, lower than at baseline, compared to the change seen among arm injury controls. Compared to the baseline assessment, children with moderate or severe TBI had significantly poorer functioning on the ABAS-II and poorer participation in activities (CASP). There was no significant improvement in any group on any outcomes between 24 and 36 months. Post-injury interventions that decrease the impact of these deficits on function and quality of life, as well as preventive interventions that reduce the likelihood of TBI, should be developed and tested.
