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Neurobehavioral sequelae of severe pediatric traumatic brain injury: a cohort study
T L Massagli1, K M Jaffe, G C Fay
1Department of Rehabilitation, Children's Hospital and Medical Center, Seattle, WA 98105, USA.
Insights
Children with severe traumatic brain injury (TBI) experience significant neurobehavioral deficits that persist one year later. Injury severity directly correlates with the magnitude of these deficits, highlighting the need for matched controls in assessments.
Area of Science:
- Pediatric Neuropsychology
- Traumatic Brain Injury Research
- Neuroscience
Background:
- Severe traumatic brain injury (TBI) in children can lead to lasting cognitive and behavioral impairments.
- Understanding the long-term neurobehavioral consequences of pediatric TBI is crucial for effective rehabilitation and support.
- Accurate assessment of TBI-related deficits requires appropriate comparison groups.
Purpose of the Study:
- To quantify neurobehavioral deficits in children 3 weeks and 1 year after severe TBI and resolution of post-traumatic amnesia (PTA).
- To examine the relationship between the severity of TBI and the extent of neurobehavioral deficits.
- To compare the performance of children with TBI against both population norms and individually matched controls.
Main Methods:
- A prospective cohort study involving 30 children (ages 6-15) with severe TBI.
- Injury severity was assessed using the Glasgow Coma Scale (GCS) and time to GCS 15.
- Neurobehavioral testing was conducted at 3 weeks and 1 year post-PTA resolution, with comparisons to individually matched controls.
Main Results:
- Children with severe TBI exhibited significant neurobehavioral deficits at both 3 weeks and 1 year post-PTA.
- Initial testing revealed deficits two standard deviations below controls; at 1 year, deficits were one standard deviation below controls.
- Greater impairment was associated with longer time to GCS 15 or lower initial GCS scores; population norms underestimated deficit magnitude.
Conclusions:
- Severe TBI in children leads to persistent and significant neurobehavioral deficits.
- The severity of TBI directly influences the magnitude of these long-term deficits.
- Using individually matched controls provides a more accurate assessment of TBI-related deficits than population norms.
Objectives:
To determine: (1) the magnitude of neurobehavioral deficits following severe traumatic brain injury (TBI) in children, 3 weeks and 1 year after resolution of post-traumatic amnesia (PTA); (2) the relationship between deficits and injury severity; (3) the performance of cases compared to population norms versus individually matched controls.
Design:
Prospective cohort study.
Setting:
Two regional university medical centers.
Participants:
Cases were 30 children 6 to 15 years old with severe TBI, measured by initial Glasgow Coma Scale (GCS) score and days to reach a GCS score of 15. Controls were individually matched for age, gender, and premorbid academic achievement.
Main Outcome Measures:
Subjects received the same neurobehavioral tests three weeks and one year after resolution of PTA. Outcomes included individual test scores and variables summarizing results in eight domains. Correlations were calculated between deficits, expressed as case-control differences, and injury severity.
Results:
Cases showed substantial deficits and performed significantly more poorly than controls at both initial and 1-year testing. At initial testing, cases had an overall score two standard deviations below controls. At 1-year testing their overall score was one standard deviation below controls. Greater impairment was found in those who reached a GCS score of 15 after 1 month or who had an initial GCS of 3 to 5. The proportion of cases with deficits and the magnitude of deficits at both testing times was underestimated by using population norms instead of controls.
Conclusions:
Severe TBI results in significant, persistent deficits related to the level of severity. Comparisons with population norms instead of controls underestimates deficits.