The Westmead Pediatric TBI Multidisciplinary Outcome study: Use of functional outcomes data to determine resource prioritization

Objective: To measure functional outcome in the 2 years after traumatic bra in injury (TBI) in 2 groups of children and to determine the usefulness of a TBI severity classification system for resource allocation. Design: prospective inception cohort study with 3 assessment points during the 2 years after trauma. Setting: Tertiary pediatric trauma center in Sydney, Australia. Participants: Eighty-one consecutive admissions aged 0 to 14 years. Fifty-o ne were allocated to the Mild (n =126) or Severe (n = 25) TBI groups, accor ding to preset determinants of severity; 30 admissions with non-TBI trauma constituted the control group. Main Outcome Measures: Standardized psychometric and clinical assessments o f cognition, communication and feeding ability, motor performance (ambulati on, fine and gross motor), neurologic status, self-care independence, and s chool/academic performance. Results: Those with Mild TBI severity had no significant deficits at the 2- year data point. In contrast, those in the Severe TBI group demonstrated co ntinued problems with fine motor performance, neurologic status, self care, and school/academic performance. Conclusions: A classification system has been developed that may be useful in the allocation of children with a TBI, age younger than 15 years, to 1 o f 2 severity groups early in their rehabilitation. This classification syst em may be useful in determining areas of high and low resource prioritizati on.