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Brain injury: functional outcome in children with tracheostomies and gastrostomies
M L Splaingard1, D Gaebler, P Havens
1Medical College of Wisconsin, Milwaukee.
Insights
Children with anoxic metabolic encephalopathies (AME) or traumatic brain injuries (TI) requiring tracheostomies and gastrostomies showed improved outcomes. Early functional status at six months significantly predicted long-term independence and reduced institutionalization.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Critical Care
Background:
- Children with severe brain injuries often require long-term medical support, including tracheostomies and gastrostomies.
- Understanding factors influencing survival and functional recovery is crucial for this vulnerable population.
Purpose of the Study:
- To evaluate survival, functional outcomes, and need for appliances at 6 and 24 months in children with anoxic metabolic encephalopathies (AME) or traumatic head injuries (TI).
- To identify predictors of long-term dependency and institutionalization in pediatric patients with tracheostomies and gastrostomies.
Main Methods:
- Retrospective analysis of 36 children with both tracheostomies and gastrostomies discharged from acute care.
- Assessment of survival, functional independence in three key areas, and need for appliances at 6 and 24 months post-discharge.
- Statistical analysis to determine predictors of functional status and institutionalization.
Main Results:
- Ten of 22 children with traumatic head injuries (TI) achieved functional independence by two years, compared to none of 14 with anoxic metabolic encephalopathies (AME).
- Six-month functional status strongly predicted two-year institutionalization and home care status, irrespective of injury type.
- The need for a tracheostomy at two years correlated with six-month functional status.
Conclusions:
- Early functional assessment at six months is a critical predictor of long-term outcomes, including dependency and institutionalization, in children with severe brain injuries.
- While survival is higher than in adult populations, functional recovery varies significantly between traumatic brain injuries and anoxic metabolic encephalopathies.
Abstract:
Survival, functional outcome, placement, and need for appliances at six and 24 months after either anoxic metabolic encephalopathies (AME) or traumatic head injuries (TI) were determined in 36 children with both tracheostomies and gastrostomies who were discharged from acute care hospitals. Five deaths occurred in totally dependent children with both tracheostomies and gastrostomies in place. Ten of 22 children with TI (48% of survivors) achieved independence in three functional areas by two years, whereas none of 14 with AME achieved functional independence in any area at two years (p = 0.001). Only one of the 18 who were dependent in all three areas at six months achieved partial independence in any area on reevaluation at two years. Institutionalization at two years was strongly predicted by six-month functional status (p less than 0.01). Four of 18 children dependent at six months returned to home care by two years, whereas all 16 children who achieved partial independence within six months of insult were cared for at home at two years (p less than 0.001), regardless of age or injury type. The need for tracheostomy at two years correlated with functional status at six months (p less than 0.01). Two-year survival was unexpectedly high for this group of children when compared to studies in adults. Functional status at six months is a strong predictor of dependency and institutionalization at two years.