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Severity of pediatric traumatic brain injury and neurobehavioral recovery at one year--a cohort study
K M Jaffe1, G C Fay, N L Polissar
1Department of Rehabilitation Medicine, Children's Hospital and Medical Center, Seattle, WA 98105.
Insights
Children with traumatic brain injury (TBI) show neurobehavioral deficits that worsen with injury severity. Recovery varies by TBI severity, and population norms can mask significant impairments in affected children.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Developmental Psychology
Background:
- Traumatic brain injury (TBI) in children can lead to long-term neurobehavioral deficits.
- Longitudinal studies are crucial for understanding the trajectory of recovery after pediatric TBI.
- Assessing neurobehavioral outcomes requires careful consideration of injury severity and comparison to appropriate control groups.
Purpose of the Study:
- To assess the neurobehavioral status of children one year after mild, moderate, or severe traumatic brain injury (TBI).
- To examine the dose-response relationship between TBI severity and neurobehavioral functioning.
- To investigate the impact of TBI severity on recovery and residual deficits over one year.
Main Methods:
- Longitudinal cohort study design involving 94 case-control pairs of children.
- Neurobehavioral status assessed one year after initial post-injury testing.
- Statistical analysis using Spearman correlation to examine the association between TBI severity and neurobehavioral outcomes.
Main Results:
- A significant dose-response association was found between TBI severity and performance across six neurobehavioral domains.
- Strongest correlations between severity and outcome were observed in intelligence, academic performance, and motor performance.
- Recovery over one year was dependent on TBI severity, with moderate and severe injuries showing related magnitudes of recovery and residual deficit.
Conclusions:
- Neurobehavioral deficits in children following TBI are directly related to injury severity.
- Population normative values can be misleading when evaluating TBI-related impairment in children.
- Individualized assessment comparing to matched controls is essential for accurately identifying neurobehavioral deficits and recovery in pediatric TBI.
Abstract:
As part of an ongoing longitudinal cohort study of children with mild, moderate, and severe traumatic brain injury and their matched controls, the neurobehavioral status of 94 case-control pairs was assessed one year after initial postinjury testing. There was a statistically significant dose-response association of severity with performance in all six domains of neurobehavioral functioning (intelligence, adaptive problem solving, memory, academic performance, motor performance, and psychomotor problem solving) with Spearman correlation coefficients of up to -.35, p < .001. The strongest correlations between severity and outcome were in the domains of intelligence, academic performance, and motor performance. Recovery over the year was also dependent on the severity of brain injury. Because mildly injured cases had negligible initial deficits, recovery was not at issue. However, for moderately and severely injured children, the degree of initial impairment was related to the magnitude of both recovery and residual deficit. Results showed that the use of population normative values to evaluate impairment was misleading. Although the mean scores of all severity groups fell within the normal range of standardized tests, the means for the moderately and severely injured were substantially below those of their matched controls on many tests.