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Very Long-Term Outcomes in Children Admitted in a Disorder of Consciousness After Severe Traumatic Brain Injury
Sandra Rodgin1, Stacy J Suskauer2, Julia Chen3
1Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Most children with disorders of consciousness after traumatic brain injury improved, but many had lasting functional impairments. Some showed significant gains between 1 and 2 years post-injury.
Area of Science:
- Pediatric Neurorehabilitation
- Traumatic Brain Injury Research
- Disorders of Consciousness
Background:
- Traumatic brain injury (TBI) in children can lead to disorders of consciousness (DOC), including vegetative state (VS) and minimally conscious state (MCS).
- Understanding long-term functional outcomes and recovery trajectories in pediatric TBI patients with DOC is crucial for rehabilitation planning.
Purpose of the Study:
- To investigate the functional outcomes and state of consciousness at 1 year and beyond (≥2 years) post-injury in children with TBI experiencing DOC.
- To compare outcomes between children admitted in VS versus MCS.
Main Methods:
- Retrospective chart review of 37 children (aged 2-18 years) admitted to a pediatric inpatient rehabilitation unit with low Cognitive and Linguistic Scale (CALS) scores.
- Assessment of state of consciousness and functional status using the Glasgow Outcome Scale-Extended, Pediatric Revision (GOS-E Peds) at 1-year and ≥2-year follow-ups.
Main Results:
- At admission, 43.2% were in VS and 56.8% in MCS. Children in VS had longer times to rehabilitation, lower admission CALS scores, and greater disability at follow-up.
- At 1 year, 27/37 patients (73%) had emerged from DOC. By ≥2 years, 2 more had emerged.
- Most patients (43.2%) were in the lower severe disability category (GOS-E Peds, 6) at both follow-up points. 73% had stable GOS-E Peds scores between follow-ups.
Conclusions:
- A majority of pediatric TBI patients with DOC emerged from their disorder by 1 year post-injury.
- However, most continued to exhibit significant functional impairments persisting to the most recent follow-up.
- A small subset demonstrated notable improvements between 1 and ≥2 years post-injury.
Objectives:
To investigate functional outcomes and state of consciousness at 1 year and ≥2 years postinjury in children who sustained a traumatic brain injury and were in a disorder of consciousness (DOC), either vegetative state (VS) or minimally conscious state (MCS), upon admission to inpatient rehabilitation.
Design:
Retrospective chart review.
Setting:
Pediatric inpatient rehabilitation unit.
Participants:
Children aged 2-18 years (N=37) who were admitted to inpatient rehabilitation with admission scores <30 on the Cognitive and Linguistic Scale (CALS).
Interventions:
Not applicable.
Main Outcome Measures:
Glasgow Outcome Scale- Extended, Pediatric Revision (GOS-E Peds), and state of consciousness based on previously established guidelines.
Results:
At admission, 16 children were in VS (43.2%) and 21 (56.8%) were in MCS. Children admitted in VS had a significantly longer time from injury to inpatient rehabilitation admission, lower CALS admission scores, were more likely to be in a DOC ≥28 days, and had greater disability at both follow-up time points. At the 1-year follow-up, 3 patients were in VS, 7 were in MCS, and 27 had emerged from MCS. By the time of the most recent follow-up (≥2y), 2 more patients had emerged from MCS. Across the cohort, GOS-E Peds scores at 1 year ranged from VS (GOS-E Peds, 7) to upper moderate disability (GOS-E Peds, 3). Most patients were functioning in the lower severe disability category (GOS-E Peds, 6) at 1 year (43.2%) and at the time of the most recent follow-up (43.2%). Twenty-seven patients (73.0%) showed stable GOS-E Peds scores between the 2 time points, 6 (16.2%) improved, and 4 (10.8%) were deceased.
Conclusions:
Although a majority of patients emerged from a DOC by 1 year postinjury, most continued to demonstrate notable functional impairment at the 1-year follow-up that persisted to the most recent follow-up. A small subset demonstrated important improvements between 1 year and the most recent follow-up (2 patients emerged, 6 patients showed improvement in GOS-E Peds scores).
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