PEDIATRIC TRAUMATIC BRAIN INJURY AND BURN PATIENTS IN THE CIVIL JUSTICE SYSTEM - THE PREVALENCE AND IMPACT OF PSYCHIATRIC SYMPTOMATOLOGY

The goal of this research was to conduct an assessment of psychopathol ogy in plaintiffs following pediatric traumatic brain injury (TBI) and burns and its relationship to awards of total compensatory damages. C hildhood TBI (n = 43) and burn (n = 51) plaintiffs were ascertained th rough a survey of the U.S. civil justice system involving a review of judicial opinions and verdict reporters in cases that had resulted in an award of compensatory damages in all states from 1978 to 1988. Narr ative summaries, drawn from these sources with supplemental informatio n from counsel of record, where possible, were prepared. Psychiatric a nd disability ratings were made from the summaries, blind to award dat a. Outcome measures were the pattern and prevalence of psychiatric dis orders and their correlation with the awards. It was found that psychi atric disorders, which were almost exclusively internalizing disorders (e.g., anxiety), were present in approximately 25 percent of the subj ects in each group. Psychiatric symptoms were not related to the award amount. Significantly greater awards in the TBI group were accounted for by greater disability measures. Physical disability and total disa bility (including physical and quality of life limitations) were signi ficantly and independently correlated with the award. It is concluded that the prevalence of psychiatric disorders in childhood TBI and burn plaintiffs is similar to that found in TBI and burn subjects in clini cal studies. Distribution of disorders is atypical in that externalizi ng disorders (e.g., attention deficit/hyperactivity disorder) were not commonly reported for either class of injuries. Awards are strongly c orrelated with disability variables reflecting mainly the severity of physical injury. Internalizing psychopathology may be underappreciated in decisions involving magnitude of awards following selected childho od injuries.