ASSOCIATION BETWEEN INJURY INDEXES AND OUTCOME AFTER SEVERE TRAUMATICBRAIN INJURY IN CHILDREN

Objectives: (1) To determine whether indices of traumatic brain injury (TBI) in children are associated with outcome at hospital discharge a nd 5 to 7 years later; (2) to describe persisting disabilities. Design : Retrospective, uncontrolled study of a cohort of children with sever e, nonpenetrating TBI. Setting: Consecutive admissions to a level 1 tr auma center over 2 years. Subjects: Seventy-five children younger than 17 years old were previously studied to identify predictors of disabi lity at acute care discharge. Thirty-three of the 50 survivors (66%) w ere enrolled. Main Outcome Measures: A database of variables abstracte d from medical records was available from the previous study. Subjects were surveyed about premorbid problems, school, employment, and curre nt function, and school records were reviewed. Using all information, a Glasgow Outcome Scale (GOS) score was assigned 5 to 7 years after TB I. Associations between database variables and GOS score at discharge and follow-up were examined using nonparametric analyses. The odds rat io for good recovery was calculated for all significant associations. Results: Late GOS was good recovery for 27%, moderate disability for 5 5%, and severe disability for 18%. Discharge GOS scores were related ( p less than or equal to .01) to the head Abbreviated Injury Scale scor e, Injury Severity Scale score, Glasgow Coma Scale (GCS) score measure d in the field and at 6, 24, and 72 hours, the length of coma, and ini tial discharge site. Late GOS scores were related (p less than or equa l to .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. A t follow-up, 64% were independent in mobility, 70% in self-care, and 2 4% in cognitive items on the Functional Independence Measure. Seventy percent of children received special education services. Employment hi stories were poor. Most subjects were not receiving neurological or re habilitation follow-up. Conclusions: Early and late outcome after seve re TBI are related to variables measured at and after injury. Subjects had long-term educational and vocational problems but often did not u tilize the medical model of neurorehabilitation. (C) 1996 by the Ameri can Congress of Rehabilitation Medicine and the American Academy of ph ysical Medicine and Rehabilitation.