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Clinical Factors Associated With Functional Recovery in Pediatric Traumatic Brain Injury
Meagan N Kelly1, L D Luna Lawes1, Gerald T Sibley2
1Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana.
Insights
Longer coma duration and ischemic injury in pediatric traumatic brain injury (TBI) patients are linked to poorer functional recovery and cognitive outcomes. Early identification of these factors is crucial for effective rehabilitation.
Area of Science:
- Neuroscience
- Pediatric Rehabilitation
- Trauma Care
Background:
- Traumatic brain injury (TBI) is a significant cause of death and disability in children.
- Long-term neurorecovery after pediatric TBI remains poorly understood.
- Factors influencing functional outcomes require further investigation.
Purpose of the Study:
- To investigate the association between coma duration, ischemic injury, and seizure activity with functional outcomes in pediatric TBI patients undergoing inpatient rehabilitation (IPR).
- To analyze the impact of these factors on self-care, mobility, and cognitive recovery.
Main Methods:
- Retrospective review of pediatric trauma patients (<18 years) admitted to an accredited pediatric IPR unit post-TBI.
- Classification of patients into short (≤7 days) and long (>7 days) coma duration groups.
- Assessment of functional outcomes using pediatric Functional Independence Measure (P-FIM) scores at admission and discharge.
Main Results:
- Ischemic injury was associated with significantly lower cognitive P-FIM scores at both admission and discharge (P<0.05).
- Long coma duration (>7 days) was independently linked to reduced self-care (RR: 0.80) and mobility (RR: 0.82) outcomes.
- 111 patients were included; 23% had ischemic injury, and 31% experienced post-traumatic seizures.
Conclusions:
- Coma duration, ischemic injury, and seizure activity are key factors influencing functional recovery after pediatric TBI.
- Longer coma duration correlates with increased resource utilization and diminished return to baseline function.
- Targeted, individualized rehabilitation strategies are essential for optimizing outcomes in pediatric TBI survivors.
Introduction:
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality in the United States, but little is known about long-term neurorecovery. We investigated the association between coma duration, ischemic injury, and seizure activity on post-TBI functional outcomes among pediatric patients admitted to inpatient rehabilitation (IPR).
Methods:
A retrospective review of pediatric and adolescent trauma patients (<18 y) admitted to an accredited pediatric IPR unit after TBI was performed. Patients were classified into short (≤7 d) and long (>7 d) coma duration. Outcomes were measured through the pediatric Functional Independence Measure scores measured at IPR admission and discharge, comparing subdomains of self-care, mobility, and cognition.
Results:
A total of 111 patients met the inclusion criteria, with 57% experiencing short coma and 43% long coma. Most injuries were blunt with intracranial hemorrhage. Ischemic injury occurred in 23% and post-traumatic seizures in 31% of patients. Ischemic injury was associated with lower cognitive Functional Independence Measure scores at both admission (8.46 ± 6.03 versus 11.95 ± 7.83, P = 0.0195) and discharge (13.46 ± 9.73 versus 18.76 ± 8.92, P = 0.0054). Long coma was independently associated with lower self-care (relative rate: 0.80; 95% confidence interval: 0.66-0.96) and mobility outcomes (relative rate: 0.82; 95% confidence interval: 0.68-0.98).
Conclusions:
Coma duration, injury mechanism, ischemic injury, and seizure activity emerged as factors associated with functional recovery after TBI. Long coma duration was associated with increased hospital and rehabilitation resource utilization and lower likelihood of return to baseline function. Patients with ischemic injury demonstrated lower cognitive recovery scores, consistent with prior literature. Early recognition of these factors can guide therapy, family counseling, and discharge planning. These findings highlight the importance of targeted and individualized rehabilitation strategies for pediatric TBI patients.
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