Follow-Up Care Adherence After Hospital Discharge in Children With Traumatic Brain Injury

Spaw, Alexandra J.; Lundine, Jennifer P.; Johnson, Sarah A.; Peng, Jin; Wheeler, Krista K.; Shi, Junxin; Yang, Ginger; Haley, Kathy; Groner, Jonathan I.; Xiang, Henry

doi:10.1097/htr.0000000000000314

Cited by 20 publications

(14 citation statements)

References 26 publications

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“…Our results are consistent with many previous studies conducted in adults (29,40) or with cross-sectional studies in children (16). Not surprisingly, the long-term follow-up of these children was difficult as reported by a recent study (41), which stated a 46% rate of non or partial adherence to medical follow-up in children after severe TBI. In our study, we experienced the same difficulties of non or partial adherence.…”

Section: Discussionsupporting

confidence: 92%

Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

Dassa

Crosnier

Chevignard

et al. 2019

European Journal of Endocrinology

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Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3–4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<−1 DS) or low IGF-1 (<−2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5–10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4–6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.

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Section: Discussionsupporting

confidence: 92%

Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

Dassa

Crosnier

Chevignard

et al. 2019

European Journal of Endocrinology

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“…Accurate comparison of the reported patient outcome results with literature is challenging because outcome in TBI is highly variable and dependent on patient characteristics, circumstances, social context, and treatment [7, 9, 13, 21, 31]. Nonetheless, the important result that even the most severely injured TBI patients can, although a small number, achieve favorable outcome (GOS) and good quality of life (QOLIBRI) is supported by recent literature [36, 42].…”

Section: Discussionmentioning

confidence: 99%

“…Also, a large number of patients had an initial low GCS and/or pupillary abnormalities. These three factors are known to negatively influence outcome and sometimes these patients are even considered unsalvageable [9, 13, 42]. Nevertheless, neurosurgical intervention was performed in up to 98% of patients with s-TBI.…”

Section: Discussionmentioning

confidence: 99%

Functional and patient-reported outcome versus in-hospital costs after traumatic acute subdural hematoma (t-ASDH): a neurosurgical paradox?

et al. 2019

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Background The decision whether to operate or not in patients with a traumatic acute subdural hematoma (t-ASDH) can, in many cases, be a neurosurgical dilemma. There is a general conception that operating on severe cases leads to the survival of severely disabled patients and is associated with relatively high medical costs. There is however little information on the quality of life of patients after operation for t-ASDH, let alone on the cost-effectiveness. Methods This study retrospectively investigated patient outcome and in-hospital costs for 108 consecutive patients with a t-ASDH. Patient outcome was assessed using the Glasgow Outcome Score (GOS) and the Traumatic Brain Injury (TBI)–specific QOLIBRI questionnaire. The in-hospital costs were calculated using the Dutch guidelines for costs calculation. Results Out of 108 patients, 40 were classified as having sustained a mild (Glasgow Coma Scale (GCS) 13–15), 19 a moderate (GCS 9–12), and 49 a severe (GCS 3–8) TBI. As expected, mortality rates increased with higher TBI severity (23%, 47%, and 61% respectively), whereas the chance for favorable outcome (GOS 4–5) decreased (72%, 47%, and 29%). Interestingly, the mean QOLIBRI scores for survivors were quite similar between the TBI severity groups (61, 61, and 64). Healthcare consumption and in-hospital costs increased with TBI severity. In-hospital costs were relatively high (€24,980), especially after emergency surgery (€28,670) and when additional ICP monitoring was used (€36,580). Conclusions Although this study confirms that outcome is often “unfavorable” after t-ASDH, it also shows that “favorable” outcome can be achieved, even in the most severely injured patients. In-hospital treatment costs were substantial and mainly related to TBI severity, with admission and surgery as main cost drivers. These results serve as a basis for necessary future research focusing on the value-based cost-effectiveness of surgical treatment of patients with a t-ASDH. Electronic supplementary material The online version of this article (10.1007/s00701-019-03878-5) contains supplementary material, which is available to authorized users.

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“…Although we incorporate these group differences in our statistical analyses, smaller numbers of participants at later points may limit the power of our results and the generalizability of these findings. Loss to follow-up is not uncommon and may be influenced by specific factors (eg, families not perceiving a need for services, socioeconomic factors, and insurance limitations) 33–35. Although those who were lost to follow-up and those who attended the 1-year follow-up did not differ on the metrics we compared in Table 2, we did not have records on other important environmental and socioeconomic factors and thus were unable to examine their role in predicting outcome.…”

Section: Discussionmentioning

confidence: 97%

“…Loss to follow-up is not uncommon and may be influenced by specific factors (eg, families not perceiving a need for services, socioeconomic factors, and insurance limitations). [33][34][35] Although those who were lost to follow-up and those who attended the 1-year follow-up did not differ on the metrics we compared in Table 2, we did not have records on other important environmental and socioeconomic factors and thus were unable to examine their role in predicting outcome. Future, prospective work should collect data related to prior head injury, socioeconomic status, and other social determinants of health that have been found to impact service access.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment

Lundine

Koterba

Shield

et al. 2022

Journal of Head Trauma Rehabilitation

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Objective: To examine predictive utility of the Glasgow Coma Scale (GCS), time to follow commands (TFC), length of posttraumatic amnesia (PTA), duration of impaired consciousness (TFC+PTA), and the Cognitive and Linguistic Scale (CALS) scores in predicting outcomes on the Glasgow Outcome Scale–Extended, Pediatric Revision (GOS-E Peds) for children with traumatic brain injury (TBI) at 2 months and 1 year after discharge from rehabilitation. Setting: A large, urban pediatric medical center and inpatient rehabilitation program. Participants: Sixty youth with moderate-to-severe TBI (mean age at injury = 13.7 years; range = 5-20). Design: A retrospective chart review. Main Measures: Lowest postresuscitation GCS, TFC, PTA, TFC+PTA, inpatient rehabilitation admission and discharge CALS scores, GOS-E Peds at 2-month and 1-year follow-ups. Results: CALS scores were significantly correlated with the GOS-E Peds at both time points (weak-to-moderate correlation for admission scores and moderate correlation for discharge scores). TFC and TFC+PTA were correlated with GOS-E Peds scores at a 2-month follow-up and TFC remained a predictor at a 1-year follow-up. The GCS and PTA were not correlated with the GOS-E Peds. In the stepwise linear regression model, only the CALS at discharge was a significant predictor of the GOS-E Peds at the 2-month and 1-year follow-ups. Conclusions: In our correlational analysis, better performance on the CALS was associated with less long-term disability, and longer TFC was associated with more long-term disability, as measured by the GOS-E Peds. In this sample, the CALS at discharge was the only retained significant predictor of GOS-E Peds scores at 2-month and 1-year follow-ups, accounting for roughly 25% of the variance in GOS-E scores. As previous research suggests, variables related to rate of recovery may be better predictors of outcome than variables related to severity of injury at a single time point (eg, GCS). Future multisite studies are needed to increase sample size and standardize data collection methods for clinical and research purposes.

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Follow-Up Care Adherence After Hospital Discharge in Children With Traumatic Brain Injury

Abstract: Nearly 20% of children hospitalized for TBI never returned for outpatient follow-up and 27% missed appointments. Care providers need to educate families, coordinate service provision, and promote long-term monitoring.

Cited by 20 publications

References 26 publications

Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

Functional and patient-reported outcome versus in-hospital costs after traumatic acute subdural hematoma (t-ASDH): a neurosurgical paradox?

Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment

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