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Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Postdischarge Care of Pediatric Traumatic Brain Injury in Argentina: A Multicenter Randomized Controlled Trial
Nancy A Carney1, Gustavo J Petroni, Silvia B Luján
11Oregon Health and Science University, Portland, OR. 2Centro de Informática e Investigación Clínica, Rosario, Argentina. 3Universidad Nacional de Rosario, Rosario, Argentina. 4Hospital de Niños Víctor J Vilela, Rosario, Argentina. 5Department of Psychology, Portland State University, Portland, OR. 6Sistema Integrado de Emergencia Sanitaria, Rosario, Argentina. 7Hospital El Cruce, Florencio Varela, Argentina. 8University of Washington, Seattle, WA. 9Hospital Interzonal Especializado Materno Infantil Dr. Vitorio Tetamanti, Mar del Plata, Argentina. 10Hospital de Niños Sor María Ludovica, La Plata, Argentina. 11Hospital de Niños "Dr. Orlando Alassia", Santa Fe, Argentina. 12Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina. 13Hospital Pediátrico Dr. Humberto Notti, Mendoza, Argentina.
Insights
A postdischarge intervention for pediatric traumatic brain injury (TBI) showed no significant effect on functional outcomes. However, better child outcomes correlated with improved family function post-injury.
Area of Science:
- Pediatric Traumatology
- Neurorehabilitation
- Family-Centered Care
Background:
- Traumatic brain injury (TBI) significantly impacts children, necessitating effective postdischarge support.
- Developing sustainable interventions is crucial for improving long-term outcomes in pediatric TBI survivors.
Purpose of the Study:
- To co-develop and evaluate a postdischarge intervention for children with traumatic brain injury (TBI) in partnership with their families.
- To assess the intervention's effectiveness in improving functional outcomes at six months post-discharge.
Main Methods:
- A randomized controlled trial was conducted across seven Level 1 Pediatric Trauma Centers in Argentina.
- 308 pediatric patients with TBI were randomized to an intervention group (receiving support from a Community Resource Coordinator) or standard care.
- Functional outcomes were assessed at six months post-injury using a composite measure.
Main Results:
- No significant difference in the primary outcome measure was observed between the intervention and standard care groups.
- A significant positive correlation was found between the primary outcome measure and family function scores (Family Impact Module of the Pediatric Quality of Life Inventory).
- Children with better functional outcomes at six months post-injury were associated with families reporting better function.
Conclusions:
- The developed postdischarge intervention did not demonstrate a significant effect on functional outcomes for pediatric TBI patients.
- This study highlights the critical role of family function in pediatric TBI recovery.
- It represents a pioneering effort in Latin America to document the comprehensive care continuum for pediatric TBI.
Objective:
To develop, in partnership with families of children with traumatic brain injury, a postdischarge intervention that is effective, simple, and sustainable.
Design:
Randomized Controlled Trial.
Setting:
Seven Level 1 Pediatric Trauma Centers in Argentina.
Patients:
Persons less than 19 years of age admitted to one of the study hospitals with a diagnosis of severe, moderate, or complicated mild traumatic brain injury and were discharged alive.
Interventions:
Patients were randomly assigned to either the intervention or standard care group. A specially trained Community Resource Coordinator was assigned to each family in the intervention group. We hypothesized that children with severe, moderate, and complicated mild traumatic brain injury who received the intervention would have significantly better functional outcomes at 6 months post discharge than those who received standard care. We further hypothesized that there would be a direct correlation between patient outcome and measures of family function.
Measurements And Main Results:
The primary outcome measure was a composite measured at 6 months post injury. There were 308 patients included in the study (61% men). Forty-four percent sustained a complicated mild traumatic brain injury, 18% moderate, and 38% severe. Sixty-five percent of the patients were 8 years old or younger, and over 70% were transported to the hospital without ambulance assistance. There was no significant difference between groups on the primary outcome measure. There was a statistically significant correlation between the primary outcome measure and the scores on the Family Impact Module of the Pediatric Quality of Life Inventory (ρ = 0.57; p < 0.0001). Children with better outcomes lived with families reporting better function at 6 months post injury.
Conclusions:
Although no significant effect of the intervention was demonstrated, this study represents the first conducted in Latin America that documents the complete course of treatment for pediatric patients with traumatic brain injury spanning hospital transport through hospital care and into the postdischarge setting.
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