NEUROBEHAVIORAL SEQUELAE OF SEVERE PEDIATRIC TRAUMATIC BRAIN INJURY -A COHORT STUDY

Objectives: To determine: (1) the magnitude of neurobehavioral deficit s following severe traumatic brain injury (TBI) in children, 3 weeks a nd 1 year after resolution of post-traumatic amnesia (PTA); (2) the re lationship between deficits and injury severity; (3) the performance o f cases compared to population norms versus individually matched contr ols. Design: Prospective cohort study. Setting: Two regional universit y medical centers, Participants: Cases were 30 children 6 to 15 years old with severe TBI, measured by initial Glasgow Coma Scale (GCS) scor e and days to reach a GCS score of 15. Controls were individually matc hed 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 te st scores and variables summarizing results in eight domains. Correlat ions were calculated between deficits, expressed as case-control diffe rences, and injury severity. Results: Cases showed substantial deficit s and performed significantly more poorly than controls at both initia l and 1-year testing. At initial testing, cases had an overall score t wo standard deviations below controls, At I-year testing their overall score was one standard deviation below controls. Greater impairment w as found in those who reached a GCS score of 15 after 1 month or who h ad 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 r esults in significant, persistent deficits related to the level of sev erity, Comparisons with population norms instead of controls underesti mates deficits. (C) 1996 by the American Congress of Rehabilitation Me dicine