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Updated: Jan 22, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Changing Healthcare and School Needs in the First Year After Traumatic Brain Injury
Heather T Keenan1, Amy E Clark, Richard Holubkov
1Division of Critical Care, Department of Pediatrics, The University of Utah, Salt Lake City (Drs Keenan and Holubkov and Ms Clark); and Department of Pediatrics and Children's Learning Institute, University of Texas McGovern Medical School, Houston (Dr Ewing-Cobbs).
Insights
Many children experience ongoing healthcare and school needs after traumatic brain injury (TBI). Addressing these requires targeted family support interventions to improve service access and outcomes.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Child Health Services Research
Background:
- Traumatic brain injury (TBI) in children can lead to persistent and complex healthcare and educational challenges.
- Understanding the evolving nature of unmet needs post-TBI is crucial for effective intervention.
Purpose of the Study:
- To investigate the prevalence and types of unmet and unrecognized healthcare and school needs in children following TBI.
- To identify predictors of these unmet needs at both short-term (3 months) and medium-term (12 months) post-injury.
Main Methods:
- A prospective cohort study involving 322 children aged 4-15 years with TBI across two pediatric trauma centers.
- Caregiver reports and standardized measures assessed health, school service use, and unmet needs at 3 and 12 months post-TBI.
- Modified Poisson models were used to analyze child and family predictors of unmet needs.
Main Results:
- At 3 months post-TBI, 28% of children had unmet or unrecognized needs, decreasing to 24% at 12 months.
- Healthcare needs shifted from primarily physical to cognitive and socioemotional by 12 months.
- Factors like low social capital, pre-existing psychological diagnoses, age, TBI severity, low income, and family function predicted unmet needs.
Conclusions:
- A significant proportion of children experience persistent unmet healthcare and school needs after TBI.
- Interventions focused on family support systems are essential to enhance children's access to necessary services and improve outcomes.
Objective:
To examine children's unmet and unrecognized healthcare and school needs following traumatic brain injury (TBI).
Setting:
Two pediatric trauma centers.
Participants:
Children with all severity of TBI aged 4 to 15 years.
Design:
Prospective cohort.
Main Measures:
Caregivers provided child health and school service use 3 and 12 months postinjury. Unmet and unrecognized needs were categorized compared with norms on standardized physical, cognitive, socioemotional health, or academic competence measures in conjunction with caregiver report of needs and services. Modified Poisson models examined child and family predictors of unmet and unrecognized needs.
Results:
Of 322 children, 28% had unmet or unrecognized healthcare or school needs at 3 months, decreasing to 24% at 12 months. Unmet healthcare needs changed from primarily physical (79%) at 3 months to cognitive (47%) and/or socioemotional needs (68%) at 12 months. At 3 months, low social capital, preexisting psychological diagnoses, and 6 to 11 years of age predicted higher healthcare needs and severe TBI predicted higher school needs. Twelve months postinjury, prior inpatient rehabilitation, low income, and preexisting psychological diagnoses were associated with higher healthcare needs; family function was important for school and healthcare needs.
Conclusions:
Targeted interventions to provide family supports may increase children's access to services.
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