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Association between injury indices and outcome after severe traumatic brain injury in children
T L Massagli1, L J Michaud, F P Rivara
1Department of Rehabilitation Medicine, University of Washington, Seattle, USA.
Insights
Severe traumatic brain injury (TBI) in children is linked to long-term disability and poor vocational outcomes. Many children with TBI do not receive adequate neurorehabilitation services.
Area of Science:
- Pediatric Traumatology
- Neuroscience
- Rehabilitation Medicine
Background:
- Severe traumatic brain injury (TBI) in children presents significant challenges for long-term recovery and functional outcomes.
- Understanding the predictors of disability is crucial for effective intervention and support.
Purpose of the Study:
- To investigate the association between TBI indices and outcomes in children at hospital discharge and 5–7 years post-injury.
- To characterize the nature and persistence of disabilities following pediatric TBI.
Main Methods:
- A retrospective study of 33 pediatric survivors (aged <17) of severe, nonpenetrating TBI admitted to a level 1 trauma center.
- Data from medical records and follow-up surveys assessed functional status using the Glasgow Outcome Scale (GOS) and Functional Independence Measure (FIM).
- Nonparametric analyses identified associations between injury variables and GOS scores; odds ratios for good recovery were calculated.
Main Results:
- Outcomes at 5–7 years post-TBI included good recovery (27%), moderate disability (55%), and severe disability (18%).
- Injury Severity Scale, Glasgow Coma Scale (GCS) scores, coma duration, and discharge GOS predicted both acute and long-term outcomes.
- Significant long-term deficits were observed in cognitive function (24% independent), with 70% requiring special education and poor employment histories.
Conclusions:
- Early injury characteristics significantly predict both short-term and long-term outcomes in pediatric severe TBI.
- Children experience persistent educational and vocational challenges, often without adequate neurorehabilitation follow-up.
- There is a need to improve access to and utilization of neurorehabilitation services for pediatric TBI survivors.
Objectives:
(1) To determine whether indices of traumatic brain injury (TBI) in children are associated with outcome at hospital discharge and 5 to 7 years later; (2) to describe persisting disabilities.
Design:
Retrospective, uncontrolled study of a cohort of children with severe, nonpenetrating TBI.
Setting:
Consecutive admissions to a level 1 trauma center over 2 years.
Subjects:
Seventy-five children younger than 17 years old were previously studied to identify predictors of disability at acute care discharge. Thirty-three of the 50 survivors (66%) were enrolled.
Main Outcome Measures:
A database of variables abstracted from medical records was available from the previous study. Subjects were surveyed about premorbid problems, school, employment, and current function, and school records were reviewed. Using all information, a Glasgow Outcome Scale (GOS) score was assigned 5 to 7 years after TBI. Associations between database variables and GOS score at discharge and follow-up were examined using nonparametric analyses. The odds ratio for good recovery was calculated for all significant associations.
Results:
Late GOS was good recovery for 27%, moderate disability for 55%, and severe disability for 18%. Discharge GOS scores were related (p < or = .01) to the head Abbreviated Injury Scale score, Injury Severity Scale score, Glasgow Coma Scale (GCS) score measured in the field and at 6, 24, and 72 hours, the length of coma, and initial discharge site. Late GOS scores were related (p < or = .01) to the same variables except the field and 6-hour GCS scores, as well as pupillary responses in the field and the discharge GOS. At follow-up, 64% were independent in mobility, 70% in self-care, and 24% in cognitive items on the Functional Independence Measure. Seventy percent of children received special education services. Employment histories were poor. Most subjects were not receiving neurological or rehabilitation follow-up.
Conclusions:
Early and late outcome after severe TBI are related to variables measured at and after injury. Subjects had long-term educational and vocational problems but often did not utilize the medical model of neurorehabilitation.