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Long-term functional outcome after moderate-to-severe paediatric traumatic brain injury
Sharon Shaklai1, Relly Peretz, Raluca Spasser
1Pediatric Unit, Loewenstein Rehabilitation Hospital , Ra'anana , Israel and.
Insights
Children with severe or moderate traumatic brain injury (TBI) often achieve age-appropriate function. Positive predictors include higher Glasgow Coma Scale scores and better rehabilitation outcomes, suggesting guarded optimism for recovery.
Area of Science:
- Pediatric Neurology
- Neurorehabilitation
- Developmental Psychology
Background:
- Limited long-term follow-up studies exist for pediatric severe and moderate traumatic brain injury (TBI).
- Existing research primarily focuses on neurobehavioral outcomes, with less data on age-appropriate functional recovery.
- Prognostic factors for pediatric TBI have been identified but require further investigation in long-term contexts.
Purpose of the Study:
- To describe the functional long-term outcomes in children following moderate and severe TBI.
- To identify factors influencing prognosis in pediatric TBI survivors.
- To provide insights into age-appropriate functioning after childhood TBI.
Main Methods:
- Prospective historical cohort study design.
- Follow-up of 77 children with moderate or severe TBI for an average of 10 years.
- Assessment of clinical functional outcomes and investigation of prognostic factors.
Main Results:
- Most children (all but six) were integrated into educational systems post-rehabilitation.
- 61% of children with severe-moderate TBI achieved age-appropriate functioning.
- Positive predictors included higher Glasgow Coma Scale (GCS), shorter unconsciousness (LOC), better Functional Independence Measure (FIM) and Intelligence Quotient (IQ) at discharge, and shorter hospital/rehabilitation stays.
- Negative predictors included vegetative state on admission and associated anoxic brain injury.
Conclusions:
- A guarded optimistic functional outcome is anticipated for children surviving severe or moderate TBI.
- Early indicators like GCS and FIM scores, alongside rehabilitation length, are crucial for predicting long-term function.
- Further research should focus on comprehensive functional assessment beyond neurobehavioral sequelae.
Background:
Long-term follow-up studies after severe and moderate pediatric traumatic brain injury (TBI) are not common and inconclusive. Most studies focused on neurobehavioural sequelae, less data is reported about age appropriate function. Different prognostic factors were noted over past decades.
Methods:
A prospective historical study describing the functional long-term outcome after childhood moderate and severe TBI was conducted. Seventy-seven children who suffered either severe or moderate TBI were followed for an average of ten years and clinical functional outcome was recorded. Factors influencing prognosis were investigated.
Results:
All children but six were integrated into educational systems after discharge from rehabilitation settings (department and day-care); 61% of children who suffered severe-moderate TBI were able to function within their normative age peers. Positive outcome predictors were Glasgow Coma Scale (GCS) >5, length of unconsciousness (LOC) <11 days, Functional Independence Measure (FIM) and Intelligence Quotient (IQ) at discharge from rehabilitation, length of acute hospitalization and rehabilitation. Negative outcome predictors were vegetative state at admission to rehabilitation and associated anoxic brain injury.
Conclusions:
Guarded optimistic functional outcome can be expected after severe or moderate childhood TBI.
