Predictors of acute child and family outcome following traumatic brain injury in children

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 chil dren. Design: Prospective, longitudinal, between-group design, comparing pr einjury and postinjury measures of functional outcome across three levels o f injury severity. Subjects: One hundred and twelve children, aged 2-12 yea rs admitted to the Royal Children's Hospital, Melbourne, with a diagnosis o f TBI. The sample was divided into three groups, according to injury severi ty: mild TBI (n = 31), moderate TBI (n = 52) and severe TBI (n = 29). Child ren with a history of neurologic, developmental and psychiatric disorder we re 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 fun ctioning, and level of family burden. Results: A clear dose-response relati on ship for physical and cognitive outcomes was found, with severe TBI asso ciated with greater impairment of physical, intellectual, memory and attent ional function. For psychosocial outcome, results were less clearly linked to injury severity. Preinjury behavioral and family functioning were closel y related to postinjury function in these domains, with an interaction iden tified between family function and child behavior at 6 months postinjury. F amily functioning remained unchanged postinjury, although level of burden w as high, and predicted by injury severity, functional impairment and postin jury behavioral disturbance. Conclusions: These results suggest ongoing fun ctional problems for the child and significant family burden 6 months follo wing TBI. The nature and severity of physical and cognitive problems are mo st closely related to injury severity, with family functioning and child be havior better predicted by psychosocial and premorbid factors. Copyright (C ) 2001 S. Karger AG, Basel.