Predictors of Acute Child and Family Outcome following Traumatic Brain Injury in Children

Abstract

Objective: To examine the relative contributions of injury severity, level of physical and cognitive disability, child behavior and family function to short-term outcome 6 months following traumatic brain injury (TBI) in children. Design: Prospective, longitudinal, between-group design, comparing preinjury and postinjury measures of functional outcome across three levels of injury severity. Subjects: One hundred and twelve children, aged 2–12 years admitted to the Royal Children’s Hospital, Melbourne, with a diagnosis of TBI. The sample was divided into three groups, according to injury severity: mild TBI (n = 31), moderate TBI (n = 52) and severe TBI (n = 29). Children with a history of neurologic, developmental and psychiatric disorder were excluded from participation. Main Outcome Measures: Levels of postinjury functioning in the following domains: physical function, cognitive ability (incorporating intellect, memory and attention), behavioral and family functioning, and level of family burden. Results: A clear dose-response relationship for physical and cognitive outcomes was found, with severe TBI associated with greater impairment of physical, intellectual, memory and attentional function. For psychosocial outcome, results were less clearly linked to injury severity. Preinjury behavioral and family functioning were closely related to postinjury function in these domains, with an interaction identified between family function and child behavior at 6 months postinjury. Family functioning remained unchanged postinjury, although level of burden was high, and predicted by injury severity, functional impairment and postinjury behavioral disturbance. Conclusions: These results suggest ongoing functional problems for the child and significant family burden 6 months following TBI. The nature and severity of physical and cognitive problems are most closely related to injury severity, with family functioning and child behavior better predicted by psychosocial and premorbid factors.

Behaviour and school performance after brain injury

“…It was not possible to identify exactly how these elements are inter-related. Behavioural problems after TBI have been linked with pre-injury behavioural and family functioning by several authors [16,39,40] and with social deprivation.…”

Physiological and Pathological Responses to Head Rotations in Toddler Piglets

“…Cognitive and motor function deficits are more severe in children younger than 4 years of age compared to older children (Agran et al, 2003;Anderson et al, 2001;Levin et al, 1992;Verger et al, 2000). Also, closed head injury in infants often results in diffuse brain atrophy, which is rarely observed in older children (Duhaime and Raghupathi, 1999).…”

Current Opinions on Epidemiology, Treatment and Outcome After Traumatic Brain Injury

“…Increasing clinical experiences and improved treatment algorithms reduced mortality of paediatric TBI during the last decades [20]. Similar to adult TBI, prediction of outcome in survivors is described to be complex, with several factors like the injury severity [27,28], rehabilitation and social support interacting to determine the extent of residual impairments [28]. Anatomic variances to adults like a disproportional large and heavy head with weak neck muscles as well as greater flexibility of cranial bones minimize focal brain injuries but increase the risk of diffuse brain injuries [20,[29][30][31][32][33][34][35][36].…”

“…In pre-school children, the brain is rapidly developing with considerable cognitive skill maturation, and might be most vulnerable to disruptions caused by TBI compared to elder children [20,28,38,39]. Differences referring to outcome were demonstrated between pre-school aged children (0 to 7 years) and school-aged children (8 to 17 years).…”

“…Consequently, significant differences after rehabilitation of pre-school children compared to school-aged children referring to increased social and behavioural impairment have been analysed [20,40]. In contrast to this assumption, the association of injury severity and outcome deficits diminishes with increasing time since injury [28,36,41], suggesting other influencing factors like social and family environment [37,42].…”