Functional outcome after severe childhood traumatic brain injury: Results of the TGE prospective longitudinal study - 20/02/21
, Leila Francillette d, Mélanie Araujo e, Hanna Toure a, Dominique Brugel a, Anne Laurent-Vannier a, Linda Ewing-Cobbs f, Philippe Meyer g, h, Georges Dellatolas c, j, Laurence Watier i, Mathilde Chevignard a, d, j
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Highlights |
• | Childhood severe traumatic brain injury (TBI) has a long-term impact on morbidity and functional deficits. |
• | Up to 80% of children presented significant disability at 2 years post-TBI. |
• | Socio-behavioural and cognitive deficits were the most common long-lasting sequelae. |
• | Functional outcome at 2 years post-TBI was highly predicted by injury severity. |
• | Multimodal assessment and follow-up could improve interventions and outcomes. |
Abstract |
Background |
Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but little is known about functional outcome.
Objective |
We aimed to 1) study clinical recovery and functional outcome over 24 months after severe childhood TBI, 2) identify early sociodemographic and severity factors influencing outcome, and 3) examine the clinical utility of the Pediatric Injury Functional Outcome Scale (PIFOS) to assess functional outcome.
Methods |
Children (0-15 years) consecutively admitted in a trauma centre after accidental severe TBI over 3 years were included in a prospective longitudinal study (Traumatisme Grave de l’Enfant cohort). We measured clinical/neurological recovery, functional status (Pediatric Injury Functional Outcome Scale, [PIFOS]), overall disability (pediatric Glasgow Outcome Scale [GOS-Peds]) as well as intellectual ability (Wechsler scales) and educational outcome (mainstream school vs special education) of survivors at 1, 3, 12 and 24 months post-injury.
Results |
For 45 children (aged 3 to 15 years at injury), functional impairments were severe within the first 3 months. Despite the initial rapid clinical recovery and significant improvement over the first year, substantial alterations persisted for most children at 12 months post-TBI, with no significant improvement up to 2 years. Up to 80% of children still had moderate or severe overall disability (GOS-Peds) at 24 months. The severity of functional impairments (PIFOS) at 12 and 24 months was mostly related to socio-emotional, cognitive and physical impairments, and was significantly correlated with clinical/neurological deficits and cognitive (intellectual, executive) and behavioural disorders. Initial TBI severity was the main prognostic factor associated with functional status over the first 2 years post-injury.
Conclusions |
Our results confirm the significant impact of severe childhood TBI on short- and medium-term functional outcomes and overall disability. All patients should benefit from systematic follow-up. The PIFOS appeared to be an accurate and reliable tool to assess functional impairment evolution and clinically meaningful outcomes over the first 2 years post-injury.
Le texte complet de cet article est disponible en PDF.Keywords : Severe traumatic brain injury, Child, Functional outcome, Longitudinal cohort study, Overall disability, Long-term follow-up
Plan
Vol 64 - N° 1
Article 101375- janvier 2021 Retour au numéro
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