Prevalence of and risk factors for poor functioning after isolated mild traumatic brain injury in children
Mark R Zonfrillo1, Dennis R Durbin, Thomas D Koepsell
11 Center for Injury Research and Prevention, and the Division of Emergency Medicine, The Children's Hospital of Philadelphia; Department of Pediatrics and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Insights
Pediatric mild traumatic brain injury (TBI) can lead to poor quality of life. Socioeconomic factors like low income and parental education predict worse outcomes in children with mild TBI.
Area of Science:
- Pediatric neurology
- Neuroscience
- Public health
Background:
- Mild traumatic brain injury (TBI) is common in children.
- Long-term quality of life (QOL) impacts are not fully understood.
- Predictors of poor QOL after pediatric mild TBI require investigation.
Purpose of the Study:
- To determine the prevalence of poor QOL outcomes at 3 and 12 months post-injury in pediatric mild TBI.
- To identify predictors of these poor QOL outcomes.
Main Methods:
- Prospective cohort study of children (<18 years) with isolated mild TBI.
- Quality of life measured using the Pediatric Quality of Life index (PedsQL).
- Poor functioning defined as a >15-point decrease in PedsQL score from baseline.
Main Results:
- Prevalence of poor functioning was 11.3% at 3 months and 12.9% at 12 months.
- Predictors included lower parental education, Hispanic ethnicity (3 months), low household income, and Medicaid insurance (12 months).
Conclusions:
- A significant proportion of children experience poor QOL after mild TBI.
- Socioeconomic disadvantage is linked to poorer QOL outcomes.
- Targeted interventions may be needed for vulnerable pediatric populations post-mild TBI.
Abstract:
This study aimed to determine the prevalence and predictors of poor 3 and 12 month quality of life outcomes in a cohort of pediatric patients with isolated mild TBI. We conducted a prospective cohort study of children and adolescents <18 years of age treated for an isolated mild TBI, defined as "no radiographically apparent intracranial injury" or "an isolated skull fracture, and no other clinically significant non-brain injuries." The main outcome measure was the change in quality of life from baseline at 3 and 12 months following injury, as measured by the Pediatric Quality of Life index (PedsQL). Poor functioning was defined as a decrease in total PedsQL score of >15 points between baseline and follow-up scores (at 3 and 12 months). Of the 329 patients who met inclusion criteria, 11.3% (95% CI 8.3-15.3%) at 3 months and 12.9% (95% CI 9.6-17.2%) at 12 months following injury had relatively poor functioning. Significant predictors of poor functioning included less parental education, Hispanic ethnicity (at 3 months following injury, but not at 12 months); low household income (at 3 and 12 months), and Medicaid insurance (at 12 months only). Children and adolescents sustaining a mild TBI who are socioeconomically disadvantaged may require additional intervention to mitigate the effects of mild TBI on their functioning.
